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The evolution of modern medicine; a serie

3 1924 007 603 982

THE EVOLUTION OF
MODERN MEDICINE

SILLIMAN MEMORIAL LECTURES
PUBLISHED BY YALE UNIVERSITY PRESS

ELECTRICITY AND MATTER. By Joseph John Thomson, d.sc, ll.d., ph.d.,
F.H.S., Fellow of Trinity College and Cavendish Professor of Experimental Physics,
Cambridge University. {Fourth printing.)

THE INTEGRATIVE ACTION OF THE NERVOUS SYSTEM. By Charles
S. Sherrington, d.sc, m.d., hon. ll.d. tor., f.r.s.. Holt Professor of Physiology,
University of Liverpool. {Fifth printing.^

RADIOACTIVE TRANSFORMATIONS. By Ernest Rutherford, d.sc, ll.d.,
F.R.S., Macdonald Professor of Physics, McGill University.

EXPERIMENTAL AND THEORETICAL APPLICATIONS OF THERMO-
DYNAMICS TO CHEMISTRY. By Dr. Walter Nernst, Professor and
Director of the Institute of Physical Chemistry in the University of Berlin.

PROBLEMS OF GENETICS. By William Bateson, m.a., f.r.s.. Director of the
John Innes Horticultural Institution, Merton Park, Surrey, England. {Second
printing.)

STELLAR MOTIONS. With Special Reference to Motions Determined by Means
of the Spectrograph. By William Wallace Campbell, sc.d., ll.d.. Director of
the Lick Observatory, University of California.

THEORIES OF SOLUTIONS. By Svante Arhhenius, ph.d., sc.d., m.d.. Director
of the Physico-Chemical Department of the Nobel Institute, Stockholm, Sweden.
{Third printing.)

IRRITABILITY. A Physiological Analysis of the General Effect of Stimuli in
Living Substances. By Max Verworn, m.d., ph.d.. Professor at Bonn Physio-
logical Institute. {Second printing.)

PROBLEMS OF AMERICAN GEOLOGY. By William North Rice, Frank D.
Adams, Arthur P. Coleman, Ch.\rles D. Walcott, Waldemar Lindgren,
Frederick Leslie Ransome, and William D. Matthew. {Second printing.)

THE PROBLEM OF VOLCANISM. By Joseph Paxson Iddings, ph.b., sc.d.
{Second printing.)

ORGANISM AND ENVIRONMENT AS ILLUSTRATED BY THE PHYSI-
OLOGY OF BREATHING. By John Scott Haldane, m.d., ll.d., f.r.s..
Fellow of New College, Oxford University. {Second printing.)

A CENTURY OF SCIENCE IN AMERICA. With Special Reference to the
American Journal of Science 1818-1918. By Edward Salisbury Dana, Charles
Schuchert, Herbert E. Gregory, Joseph Barrell, George Otis Smith,
Richard Swann Lull, Louis V. Pirsson, William E. Ford, R. B. Sosman,
Horace L. Wells, Harry W. Foote, Leigh Page, Wesley R. Coe, and George
L. Goodale.

THE EVOLUTION OF MODERN MEDICINE. By Sir William Osler, bart.,

M.D., F.R.S.

RESPIRATION. By J. S. Haldane, m.a., m.d., f.r.s., hon. ll.d. birm. and edin..
Fellow of New College, Oxford,- Honorary Professor, Birm,ingham University.

THE EVOLUTION OF

MODERN MEDICINE

A Series of Lectures Delivered at Yale University
on the Silliman Foundation in April, 1913,

By

Sir WILLIAM OSLER, Bart., M.D., F.R.S.

NEW HAVEN
YALE UNIVERSITY PRESS

LONDON ■ HUMPHREY MILFORD • OXFORD UNIVERSITY PRESS

MDCCCCXXI

^S\\^^

b

COPYRIGHT, 1921, BY
YALE IINIVEESITY PEESS

THE SILLIMAN FOUNDATION

IN the year 1883 a legacy of eighty thousand dollars was left to the
President and Fellows of Yale College in the city of New Haven,
to be held in trust, as a gift from her children, in memory of their
beloved and honored mother, Mrs. Hepsa Ely Silliman.

On this foundation Yale College was requested and directed to
establish an annual course of lectures designed to illustrate the pres-
ence and providence, the wisdom and goodness of God, as manifested
in the natural and moral world. These were to be designated as the
Mrs. Hepsa Ely Silliman Memorial Lectures. It was the belief of
the testator that any orderly presentation of the facts of nature or
history contributed to the end of this foundation more effectively than
any attempt to emphasize the elements of doctrine or of creed ; and he
therefore provided that lectures on dogmatic or polemical theology
should be excluded from the scope of this foundation, and that the
subjects should be selected rather from the domains of natural science
, and history, giving special prominence to astronomy, chemistry,
geology and anatomy.

It was further directed that each annual course should be made the
basis of a volume to form part of a series constituting a memorial to
Mrs. Silliman. The memorial fund came into the possession of the
Corporation of Yale University in the year 1901 ; and the present
volume constitutes the tenth of the series of memorial lectures.

CONTENTS

Chapter I. Introduction 1

Chapter II. Greek Medicine 35

Chapter III Mediaeval Medicine . ... 84

Chapter IV. The Renaissance and the Rise of

Anatomy and Physiology . . 126

Chapter V. The Rise and Development of

Modern Medicine . . . .183

Chapter VI. The Rise of Preventive Medicine . 218

LIST OF ILLUSTRATIONS

PAGE

Fig. 1. Skull showing old and recent trephinings. (From Lucas-

Championniere) 8

Fig. %. The Step Pyramid (Sakkarah) 9

Fig. 3. Imhotep 10

Fig. 4- Beginning of Ebers Papyrus 12

Fig. 5. Symbols representing both Metals and Heavenly Bodies . 16

Fig. 6. Mummy with Spinal Curvature. (Ruffer) 17

Fig. 7. Clay Model of Sheep's Liver {Babylonian, circa, 2000 B. C).

(From Jastrow) 20

Bronze Model of Liver {Etruscan, circa third century

B.C.). (From Jastrow) 20

Fig. 8. Diagram of Sheep's Liver, showing modern anatomical terms

and their Babylonian equivalents. (Jastrow) .... 21

Fig. 9. Code Hammurabi. Circa 2000 B. C. (Harper) . . . 26
Figs. 10 and 11. Chinese acupuncture diagrams, showing the mainte-
nance of tradition for 1300 years (620 A. D.-1920

A. D.). (Courtesy of Dr. E. V. Cowdry, Peking, China) 32

Fig. 12. Alcmceon .' 4-0

Fig. 13. Asklepios (National Museum, Athens, from Epidauros) . 44
Fig. 14. Asklepios with Staff, and Delphic Omphalos in the right

lower corner (National Museum, Naples) .... 45
Fig. 15. Asklepios and Hygieia (with the sacred snake) (Vatican,

Rome) 46

Fig. 16. Hygieia (daughter of Asklepios) (Berlin) 47

Fig. 17. Coins representing Asklepios with snake 4^

Fig. 18. ^sculapian serpent, carved in travertine on the Isola San

Bartolommeo in the Tiber, near Rome 60

Fig. 19. Layout of Epidaurus 61

Fig. 20. Hieron at Epidaurus. (Caton) 62

Fig. 21, Temple-rite at Epidaurus. (Caton) 64

Fig, 22, Asklepieion at Cos 55

Fig. 23, Plan of the Asklepieion at Cos (from excavations of 1902-

1904) 55

X LIST OF ILLUSTRATIONS

PAGE

Fig. ^4-. Ex-votos 56

Fig. ^5. Ex-voto of a case of disease of the eye 57

Fig. 26. Modern German ex-voto of disease of the eyes .... 57

Fig. 27. Bust of Hippocrates {British Museum) 59

Fig. 28. Earliest known Manuscript of Hippocrates {ninth cen-
tury). (Codex Laurentianus, Florence) 61

Fig. 29. Acropolis at Pergamos 75

Fig. 30. Relief Map of Pergamos 76

Fig. SI. Galen and Lady Patient 77

Fig. 31a. Schema illustrating the Galenic doctrine of the circulation.
(From Harvey: La circulation du sang. Traduction

fran9aise par Charles Richet, Paris, 1879, p. 17) . . . 81

Fig. 32. Salernum, Italy 87

Fig. 33. Title-page of Regimen Sanitatis Salerni {14-80) .... 89
Fig. 34. Fifth century drawing from Anicia Juliana MS. of Dios-

corides 90

Fig. 35. The distribution of the Grwco-Roman world at the com-
mencement of the seventh century 92

Fig. 36. Arabian Empire at the commencement of the seventh century

and at the commencement of the eighth century ... 93

Fig. 37. Page from the Isagoge of Joannitius {1487) .... 96

Fig. 38. Avicenna 97

Fig. 39. Illuminated illustration from a Hebrew MS. of Avicenna in

the Bologna Library 99

Fig. 40. Page of MS. of Avicenna' s poems in the Bodleian Library . 100

Fig. 41- Tomb of Avicenna at Hamadan 101

Fig. 42. Title-page of Anathomia of Mundinus. (Melerstat ed.)

(Circa 1493) 105

Fig. 43- Tablet to Mundinus {Church of San Vitale, Bologna) . . 107

Fig. .^^. Table of the Hippocratic Humors. (Nicaise) .... 108
Fig. 45. MedicEval Dissection Scene from a fourteenth-century MS. of

Guy de Chauliac in Montpellier Library 109

Fig. 46- Page from the Practica or Thesaurus Pauperum of Pope

John XAI {i486) 112

Fig. 47 ■ Roger Bacon II4.

Fig. 48- Medical Lecture at Bologna in the Middle Ages. (From the

tomb of the physician Michele Bertalia, 1328) . . . 116
Fig. 49. Mundinus Lecturing. (From his tomb in the Church of San

Vitale, Bologna) 116

Fig. 50. Astrological Prognostication of 1546 120

LIST OF ILLUSTRATIONS xi

PAGE

Fig. 51. Horoscope of Jerome Cardan 1£1

Fig. 52. Title-page of astrological treatise by Nicholas Culpeper

(1658) 123

Fig. 53. Thomas Linacre 128

Fig. 5Jf. John Caius 129

Fig. 55. Conrad Gesner 130

Fig. 56. Paracelsus 133

Fig. 57. Title-page of Paracelsus' Treatise on Surgery {1536) . . 136
Fig. 58. Portrait and linkage of Van Helmont. (Opposite p. 1 of his

Ortus Medicinse, Elzevir ed., 164.8) 139

Fig. 59. Title-page of Digby's Powder of Sympathy (1658) . . . 14-3

Fig. 60. Nicolaus Copernicus l^-i-

Fig. 61. Andreas Vesalius. (Woodcut opposite p. 1 of the Fabrica,

154.3) 1^7

Fig. 62. Mediaeval anatomical diagram (fourteenth century). (From
Ashmolean Codex No. 399, folio 18 recto, Bodleian Li-
brary, Oxford) lJi.9

Fig. 63. Hospital frequented by Vesalius at Venice 150

Fig. 6^. Spine from Berengarius (circa 1521), an immediate prede-
cessor of Vesalius (for comparison with Fig. 70) . . . 153
Fig. 65. Skeleton preparedby Vesalius at Basel in 15^2—15^3. (Cour-
tesy of Dr. Harvey Cushing) 155

Fig. 66. Title-page of Epitome (c^ Fabrica) of Vesalius (154-3) . . 156
Figs. 67 and 68. From Vesalius' Tabulce Anatomicce (1538). The
Galenic views of the circulation (venous A: arterial B) are

shown 158

Fig. 69. Page from Vesalius' Epistle on China-root (154-6) . . . 159
Fig. 70. Spines from Vesalius and Leonardo, with a modern drawing
of the spine as a control (showing superiority of the Leo-

nardine delineation) 161

Fig. 71. Figures of bones of the foot from Leonardo and Vesalius . 162

Fig. 72. Plates from Fabricius, showing valves in the veins (1603) . 164
Fig. 73. Showing the method of demonstrating valves in veins of arm

(1603) 164-

Fig. 74- Page from Harvey's lecture of April 17, 1616 . . . . 167
Fig. 75. Title-page of Harvey's Treatise on Circulation of the Blood

(1628) . . .' 168

Fig. 76. Plate from Harvey, repeating the experiment of Fabricius . 171

Fig. 77. Frontispiece of Sanctorius' De Statica Medicina (1614) ■ 174

Fig. 78. Rene Descartes 175

Fig.

79.

Fig.

80.

Fig.

81.

Fig.

8^.

Fig.

83.

xii LIST OF ILLUSTRATIONS

PAGE

Page from the last testament of Basil Valentine {1671) . 177

Daniel Sennert 178

Title-page of Van Helmont's Ortus Medicince (1648) . . 179

Robert Boyle 180

Title-page {reduced) of William Gilbert's Treatise on the

Magnet {1600) 181

Fig. 84- Harvey's stemma set in the walls of the university at Padua

{with caduceus) 18^

First page of Benivieni's De Abditis {1507) 18Ji,

Giovanni Battista Morgagni 186

Title-page of Morgagni' s De Sedibus {1761) .... 187

Thomas Sydenham 189

Hermann Boerhaave 191

Giovanni Maria Lancisi 19^

Giorgio Baglivi 193

William Cullen 19Jp

Benjamin Rush 195

John Brown 196

John Hunter 197

Edward Jenner 198

Hand of Sarah Nelmes, inoculated with cowpow. (From

Jenner's Inquiry) 199

Title-page of Jenner's Inquiry {1798) ^00

Chart giving effect of vaccination on smallpox mortality in

the German Army 201

Fig. 100. Chart showing effect of vaccination on smallpox mortality in

the German Empire 202

Auenbrugger 203

Title-page of Laennec's Treatise on Mediate Auscultation

{1819) 204.

Statue of Laennec 205

Louis Pasteur 207

Robert Koch 210

Title-page of Koch's monograph on wound infection {with

autograph of Lister) {1878) 211

Fig. 107. Lord Lister 213

Fig.

85.

Fig.

86.

Fig.

87.

Fig.

88.

Fig.

89.

Fig.

90.

Fig.

91.

Fig.

92.

Fig.

93.

Fig.

94.

Fig.

95.

Fig.

96.

Fig.

97.

Fig.

98.

Fig.

99.

Fig.

101.

Fig.

102.

Fig.

103.

Fig.

104.

Fig.

105.

Fiq.

106.

PREFACE

THE manuscript of Sir William Osier's lectures on the "Evolu-
tion of JNIodern Medicine," delivered at Yale University in
April, 1913, on the Silliman Foundation, was immediately
turned in to the Yale University Press for publication. Duly set in
type, proofs in galley form had been submitted to him and despite
countless interruptions he had already corrected and revised a number
of the galleys when the great war came. But with the war on, he threw
himself with energy and devotion into the military and public duties
which devolved upon him and so never completed his proof-reading
and intended alterations. After the death of his son, mortally
wounded in action in the Ypres salient, he gradually lost heart for
many things he had set his mind and hand to do. The careful correc-
tions which Sir William made in the earlier galleys show that the
lectures were dictated, in the first instance, as loose memoranda for
oral delivery rather than as finished compositions for the eye, while
maintaining throughout the logical continuity and the engaging con
moto which were so characteristic of his literary style. In revising the
lectures for publication, therefore, the editors have merely endeavored
to carry out, with care and befitting reverence, the indications supplied
in the earlier galleys by Sir William himself. In supplying dates and
references which were lacking, his preferences as to editions and read-
ings have been borne in mind. The slight alterations made, the adap-
tation of the text to the eye, detract nothing from the original
freshness of the work.

In a letter to one of the editors, Osier described these lectures as "an
aeroplane flight over the progress of medicine through the ages."
They are, in effect, a sweeping panoramic survey of the whole vast
field, covering wide areas at a rapid pace, yet with an extraordinary
variety of detail. The slow, painful character of the evolution of
medicine from the fearsome, superstitious mental complex of primitive

xiv PREFACE

man, with his amulets, healing gods and disease demons, to the ideal of
a clear-eyed rationalism is traced with faith and a serene sense of
continuity.

The author saw clearly and felt deeply that the men who have made
an idea or discovery viable and valuable to humanity are the deserving
men ; he has made the great names shine out, without any depreciation
of the important work of lesser men and without cluttering up his
narrative with the tedious prehistory of great discoveries or with shrill
claims to priority. Of his skill in differentiating the sundry "strains"
of medicine, there is specific witness in each section. Osier's wide cul-
ture and control of the best available literature of his subject per-
mitted him to range the ampler tether of Greek medicine or the earth-
fettered schools of today with equal mastery; there is no quickset of
pedantry between the author and the reader. The illustrations (which
he had doubtless planned as fully for the last as for the earlier chap-
ters) are as he left them; save that, lacking legends, these have been
supplied and a few which could not be identified have with regret been
omitted. The original galley proofs have been revised and corrected
from different viewpoints by Fielding H. Garrison, Harvey Gushing,
Edward C. Streeter and latterly by Leonard L. Mackall (Savannah,
Ga.), whose zeal and persistence in the painstaking verification of
citations and references cannot be too highly commended.

This work, composed originally for a lajr audience and for popular
consumption, will be to the aspiring medical student and the hard-
working practitioner a lift into the blue, an inspiring vista or "Pisgah-
sight" of the evolution of medicine, a realization of what devotion,
perseverance, valor and ability on the part of phj^sicians have contrib-
uted to this progress, and of the creditable part which our profession
has played in the general development of science.

The editors have no hesitation in presenting these lectures to the
profession and to the reading public as one of the most characteristic
productions of the best- balanced, best-equipped, most sagacious and
most lovable of all modern physicians.

F. H. G.

BUT on that account, I say, we ought hot to reject the ancient Art,
as if it were not, and had not been properly founded, because it
did not attain accuracy in all things, but rather, since it is capable of
reaching to the greatest exactitude by reasoning, to receive it and
admire its discoveries, made from a state of great ignorance, and as
having been well and properly made, and not from chance. (Hippoc-
rates, On Ancient Medicine, Adams edition. Vol. 1, 1849, p. 168.)

THE true and lawful goal of the sciences is none other than this :
that human life be endowed with new discoveries and powers.
(Francis Bacon, Novum Organum, Aphorisms, LXXXI, Sped-
ding's translation.)

A GOLDEN thread has run throughout the history of the world,
. consecutive and continuous, the work of the best men in succes-
sive ages. From point to point it still runs, and when near you feel
it as the clear and bright and searchingly irresistible light which Truth
throws forth when great minds conceive it. (Walter Moxon, Pilo-
cereus Senilis and Other Papers, 1887, p. 4.)

FOR the mind depends so much on the temperament and disposi-
tion of the bodily organs that, if it is possible to find a means of
rendering men wiser and cleverer than they have hitherto been, I be-
lieve that it is in medicine that it must be sought. It is true that the
medicine which is now in vogue contains little of which the utility is re-
markable ; but, without having any intention of decrying it, I am sure
that there is no one, even among those who make its study a pro-
fession, who does not confess that all that men know is almost noth-
ing in comparison with what remains to be known ; and that we could
be free of an infinitude of maladies both of body and mind, and even
also possibly of the infirmities of age, if we had sufficient knowledge
of their causes, and of all the remedies with which nature has provided
us. (Descartes: Discourse on the WLethod, Philosophical Works.
Translated by E. S. Haldane and G. R. T. Ross. Vol. I, Cam. Univ.
Press, 1911, p. 120.)

CHAPTER I
INTRODUCTION

SAIL to the Pacific with some Ancient Mariner, and traverse day
by day that silent sea until you reach a region never before fur-
rowed by keel where a tiiiy island, a mere speck on the vast
ocean, has just risen from the depths, a little coral reef capped with
green, an atoll, a mimic earth, fringed with life, built up through
countless ages by life on the remains of life that has passed away.
And now, with wings of fancy, join lanthe in the magic car of Shelley,
pass the eternal gates of the flaming ramparts of the world and see
his vision :

Below lay stretched the boundless Universe!
There, far as the remotest line
That limits swift imagination's flight.
Unending orbs mingled in mazy motion,
Immutably fulfilling
Eternal Nature's law.
Above, below, around.
The circling systems formed
A wilderness of harmony.

(Daemon of the World, Pt. I.)

And somewhere, "as fast and far the chariot flew," amid the mighty
globes would be seen a tiny speck, "earth's distant orb," one of "the
smallest lights that twinkle in the heavens." Alighting, lanthe
would find something she had probably not seen elsewhere in her
magic flight — life, everywhere encircling the sphere. And as the little
coral reef out of a vast depth had been built up by generations of
polyzoa, so she would see that on the earth, through illimitable ages,
successive generations of animals and plants had left in stone their
imperishable records : and at the top of the series she would meet the
thinking, breathing creature known as man. Infinitely little as is

2 THE EVOLUTION OF MODERN MEDICINE

the architect of the atoll in proportion to the earth on which it rests,
the polyzoon, I doubt not, is much larger relatively than is man in
proportion to the vast systems of the Universe, in which he represents
an ultra-microscopic atom less ten thousand times than the tiniest of
the "gay motes that people the sunbeams." Yet, with colossal audac-
ity, this thinking atom regards himself as the anthropocentric pivot
around which revolve the eternal purposes of the Universe. Know-
ing not whence he came, why he is here, or whither he is going, man
feels himself of supreme importance, and certainly is of interest —
to himself. Let us hope that he has indeed a potency and importance
out of all proportion to his somatic insignificance. We know of
toxins of such strength that an amount too infinitesimal to be gauged
may kill; and we know that "the unit adopted in certain scientific
work is the amount of emanation produced by one million-millionth
of a grain of radium, a quantity which itself has a volume of less than
a million-millionth of a cubic millimetre and weighs a million million
times less than an exceptionally delicate chemical balance will turn
to" (Soddy) . Maj'- not man be the radium of the Universe? At any
rate let us not worry about his size. For us he is a very potent crea-
ture, full of interest, whose mundane story we are only beginning to
unravel.

Civilization is but a filmj fringe on the history of man. Go back
as far as his records carrj^ us and the story written on stone is of
yesterday in comparison with the vast epochs of time which modern
studies demand for his life on the earth. For two millions (some
hold .even three millions) of years man lived and moved and had his
being in a Avorld very different from that upon which we look out.
There appear, indeed, to have been various types of man, some as
different from us as we are from the anthropoid apes. What upstarts
of yesterday are the Pharaohs in comparison with the men who sur-
vived the tragedy of the glacial period ! The ancient history of man —
only now beginning to be studied — dates from the Pliocene or Mio-
cene period; the modern history, as we know it, embraces that brief
space of time that has elapsed since the earliest Egyptian and Baby-
lonian records were made. This has to be borne in mind in connection
with the present mental status of man, particularly in his outlook
upon nature. In his thoughts and in his attributes, mankind at large
is controlled by inherited beliefs and impulses, which countless thou-

INTRODUCTION 3

sands of years have ingrained like instinct. Over vast regions of
the earth today, magic, amulets, charms, incantations are the chief
weapons of defense against a malignant nature; and in disease, the
practice of Asa* is comparatively novel and unusual; in days of ill-
ness many millions more still seek their gods rather than the physi-
cians. In an upward path man has had to work out for himself a
relationship • with his fellows and with nature. He sought in the
supernatural an explanation of the pressing phenomena of life, peo-
pling the world with spiritual beings, deifying objects of nature, and
assigning to them benign or malign influences, which might be
invoked or propitiated. Primitive priest, physician and philosopher
were one, and struggled, on the one hand, for the recognition of cer-
tain practices forced on him by experience, and on the other, for
the recognition of mystical agencies which control the dark, "uncharted
region" about him — to use Prof. Gilbert Murray's phrase — and were
responsible for everything he could not understand, and particularly
for the mysteries of disease. Pliny remarks that physic "was early
fathered upon the gods"; and to the ordinary non-medical mind, there
is still something mysterious about sickness, something outside the
ordinary standard.

Modern anthropologists claim that both religion and medicine took
origin in magic, "that spiritual protoplasm," as Miss Jane Harrison
calls it. To primitive man, magic was the setting in motion of a
spiritual power to help or to hurt the individual, and early forms
may still be studied in the native races. This power, or "mana," as it
is called, while possessed in a certain degree by all, may be increased
by practice. Certain individuals come to possess it very strongly:
among native Australians today it is still deliberately cultivated.
Magic in healing seeks to control the demons, or forces, causing dis-
ease; and in a way it may be thus regarded as a "lineal ancestor of
modern science" (Whetham), which, too, seeks to control certain
forces, no longer, however, regarded as supernatural.

Primitive man recognized many of these superhuman agencies
relating to disease, such as the spirits of the dead, either human or
animal, independent disease demons, or individuals who might act
by controlling the spirits or agencies of disease. We see this today
among the negroes of the Southern States. A Hoodoo put upon a
negro may, if he knows of it, work upon him so powerfully through

* II Chronicles xvi, 13.

4 THE EVOLUTION OF MODERN MEDICINE

the imagination that he becomes very ill indeed, and only through a
more powerful magic exercised by someone else can the Hoodoo be
taken off.

To primitive man life seemed "full of sacred presences" (Walter
Pater) connected with objects in nature, or with incidents and epochs
in life, which he began early to deify, so that, until a quite recent
period, his story is largely associated with a pantheon of greater and
lesser gods, which he has manufactured wholesale. Xenophanes was
the earliest philosopher to recognize man's practice of making gods
in his own image and endowing them with human faculties and attri-
butes; the Thracians, he said, made their gods blue-eyed and red-
haired, the Ethiopians, snub-nosed and black, while, if oxen and lions
and horses had hands and could draw, they would represent their
gods as oxen and lions and horses. In relation to nature and to disease,
all through early history we find a pantheon full to repletion, bearing
testimony no less to the fertility of man's imagination than to the
hopes and fears which led him, in his exodus from barbarism, to
regard his gods as "pillars of fire by night, and pillars of cloud by
day"

Even so late a religion as that of Numa was full of little gods to
be invoked on special occasions — Vatican, who causes the infant to
utter his first cry, Fabulinus, who prompts his first word, Cuba, who
keeps him quiet in his cot, Domiduca, who watches over one's safe
home-coming (Walter Pater) ; and Numa believed that all diseases
came from the gods and were to be averted by prayer and sacrifice.
Besides the majgr gods, representatives of Apollo, ^sculapius and
Minerva, there were scores of lesser ones who could be invoked for
special diseases. It, is said that the young Roman mother might
appeal to no less than fourteen goddesses, from Juno Lucina to
Prosa and Portvorta (Withington). Temples were erected to the
Goddess of Fever, and she was much invoked. There is extant a
touching tablet erected by a mourning mother and inscribed :

Febri divae, Febri
Sanctas, Febri magnse
Camillo amato pro
Filio meli effecto. Posuit.

INTRODUCTION 5

It is marvellous what a long line of superhuman powers, major and
minor, man has invoked against sickness. In Swinburne's words:

God by God flits past in thunder till his glories turn' to shades,
God by God bears wondering witness how his Gospel flames and fades ;
More was each of these, while yet they were, than man their servant seemed ;
Dead are all of these, and man survives who made them while he dreamed.

Most of them have been benign and helpful gods. Into the dark
chapters relating to demonical possession and to witchcraft we can-
not here enter. They make one cry out with Lucretius (Bk. V) :

genus infelix humanura, talia divis
Cum tribuit facta atque iras adjunxit acerbas !
Quantos tum gemitus ipsi sibi, quantaque nobis
Vulnera, quas lacrimas peperere minoribu' nostris.

In every age, and in every religion there has been justification for
his bitter words, "tantum religio potuit suadere malorum" — "Such
wrongs Religion in her train doth bring" — yet, one outcome of "a
belief in spiritual beings" — as Tylor defines religion — has been that
man has built an altar of righteousness in his heart. The comparative
method applied to the study of his religious growth has shown how
man's thoughts have widened in the unceasing purpose which runs
through his spiritual no less than his physical evolution. Out of the
spiritual protoplasm of magic have evolved philosopher and physician,
as well as priest. Magic and religion control the uncharted sphere —
the supernatural, the superhuman: science seeks to know the world,
and through knowing, to control it. Ray Lankester remarks that
Man is Nature's rebel, and goes on to say: "The mental qualities
which have developed in Man, though traceable in a Vague and rudi-
mentary condition in some of his animal associates, are of such an
unprecedented power and so far dominate ev&rytliing else in his
activities as a living organism, that they have to a very large extent,
if not entirely, cut him off from the general operation of that process
of Natural Selection and survival of the fittest which up to their
appearance had been the law of the living world. They justify the
view that Man forms a new departure in the gradual unfolding of
Nature's predestined scheme. Knowledge, reason, self-consciousness,
will, are the attributes of Man.'" It has been a slow and gradual

1 Sir E. Ray Lankester: Romanes Lecture, "Nature and Man,'' Oxford Univ. Press, 1905,
p. 31.

6 THE EVOLUTION OF MODERN MEDICINE

growth, and not until within the past century has science — organized
knowledge — so searched out the secrets of Nature, as to control her
powers, limit her scope and transform her energies. The victory is
so recent that the mental attitude of the race is not yet adapted to
the change. A large proportion of our fellow creatures still regard
nature as a playground for demons and spirits to be exorcised or
invoked.

Side by side, as substance and shadow — "in the dark backward and
abysm of time," in the dawn of the great civilizations of Egypt and
Babylon; in the bright morning of Greece, and in the full noontide
of modern life, together have grown up these two diametrically oppo-
site views of man's relation to nature, and more particularly of his
personal relation to the agencies of disease.

The purpose of this course of lectures is to sketch the main features
of the growth of these two dominant ideas, to show how they have
influenced man at the different periods of his evolution, how the lamp
of reason, so early lighted in his soul, burning now bright, now dim,
has never, even in his darkest period, been wholly extinguished, but
retrimmed and refurnished by his indomitable energies, now shines
more and more towards the perfect day. It is a glorious chapter in
history, in which those who have eyes to see may read the fulfilment
of the promise of Eden, that one day man should not only possess
the earth, but that he should have dominion over it ! I propose to take
an aeroplane flight through the centuries, touching only on the tall
peaks from which may be had a panoramic view of the epochs through
which we pass.

ORIGIN OF MEDICINE

Medicine arose out of the priiiial sympathy of man with man ; out
of the desire to help those in sorrow, need and sickness.

In the primal sympathy
Which having been must ever be ;
In the soothing thoughts that spring
Out of human suffering.

The instinct of self-preservation, the longing to relieve a loved one,
and above all, the maternal passion — for such it is— gradually sof-

ORIGIN OF MEDICINE 7

tened the hard race of man — tu7ii genus hu'manum primum mollescere
coepit. In his marvellous sketch of the evolution of man, nothing
illustrates more forciblj'- the prescience of Lucretius than the picture
of the growth of sympathy: "When with cries and gestures they
taught with broken words that 'tis right for all men to have pity on
the weak." I heard the well-known medical historian, the late Dr.
Payne, remark that "the basis of medicine is sympathy and the desire
to help others, and whatever is done with this end must be called
medicine."

The first lessons came to primitive man by injuries, accidents, bites'
of beasts and serpents, perhaps for long ages not appreciated by his
childlike mind, but, little by little, such experiences crystallized into
useful knowledge. The experiments of nature made clear to him
the relation of cause and effect, but it is not likely, as Pliny suggests,
that he picked up his earliest knowledge from the observation of
certain practices in animals, as the natural phlebotomy of the plethoric
hippopotamus, or the use of emetics from the dog, or the use of
enemata from the ibis. On the other hand, Celsus is probably right in
his account of the origin of rational medicine. "Some of the sick on
account of their eagerness took food on the first day, some on account
of loathing abstained; and the disease in those who refrained was
more relieved. Some ate during a fever, some a little before it, others
after it had subsided, and those who had waited to the end did best.
For the same reason some at the beginning of an illness used a full
diet, others a spare, and the former were made worse. Occurring
daily, such things impressed careful men, who noted what had best
helped the sick, then began to prescribe them. In this way medicine
had its rise from the experience of the recovery of some, of the death
of others, distinguishing the hurtful from the salutary things"
(Book I). The association of ideas was suggestive — the plant eye-
bright was used for centuries in diseases of the eye because a black
speck in the flower suggested the pupil of the eye. The old herbals
are full of similar illustrations upon which, indeed, the so-called doc-
trine of signatures depends. Observation .came, and with it an ever
widening experience. No society so primitive without some evidence
of the existence of a healing art, which grew with its growth, and
became part of the fabric of its organization.

With primitive medicine, as such, I cannot deal, but I must refer to

8 THE EVOLUTION OF MODERN MEDICINE

FIG. 1.

Skull showing old and recent trephinings.

{From Lucas-Championniere .)

the oldest existing evidence of a very extraordinarj^ practice, that of
trephining. Neohthic skulls with disks of bone removed have been
found in nearly all parts of the world. JNIanj^ careful studies have
been made of this j^rocedure, particvilarly by the great anatomist and
surgeon, Paul Broca, and M. Lucas-Championniere has recently pub-
lished a monograj^h.' Broca suggests that the trephining was done
by scratching or scraping, but it is more likelj^ as Lucas-Champion-
niere holds, that it was done hy a series of perforations made in a circle
with flint instruments, and a round piece of skull in this waj^ removed;
traces of these drill-holes have been found. The operation was done
for epilepsy, infantile convulsions, headache, and various cerebral
diseases believed to be caused by confined demons, to whom the hole
gave a ready method of escape.

The practice is still extant. Lucas-Championniere saw a Kabyle
thoubib who told him that it Avas quite common among his tribe; he
was the son of a family of trephiners, and had undergone the opera-

2 Lucas-Championnitre: Trepanation neolitliique, Paris, 1912.

EGYPTIAN MEDICINE 9

tion four times, his father twelve times; he had three brothers also
experts; he did not consider it a dangerous operation. He did it most
frequently for pain in the head, and occasionally for fracture.

The operation was sometimes performed upon animals. Shepherds
trephined sheep for the staggers. We may say that the modern
decompression operation, so much in vogue, is the oldest known surgi-,
cal procedure.

EGYPTIAN MEDICINE

Out of the ocean of oblivion, man emerges in history in a highly
civilized state on the banks of the Nile, some sixty centuries ago.
After millenniums of a gradual upward progress, which can be
traced in the records of the stone age, civilization springs forth
Minerva-like, complete, and highly developed, in the Nile Valley.
In this sheltered, fertile spot, neolithic man first raised himself above
his kindred races of the Mediterranean basin, and it is suggested that
by the accidental discovery of copper Egypt "forged the instruments

FIG. '-2.

The Step Pyramid.

{Sakkarah.)

10 THE EVOLUTION OF MODERN MEDICINE

that raised civilization out of the slough of the Stone Age" (Elliot
Smith). However this may be, of special interest to us is the fact
that one of the best-known names of this earliest period is that of a
physician — guide, philosopher and friend of the king — a man in a
position of wide trust and importance. Leaving Cairo, one sees on
the right in the desert behind Memphis a terraced
pyramid 190 feet in height, "the first large struc-
ture of stone known in history:" It is the royal
tomb of Zoser, the first of a long series with which
the Egj'^ptian monarchy sought "to adorn the
coming bulk of death." The design of this is attrib-
uted to Imhotep, the first figure of a physician to
stand out clearly from the mists of antiquity. "In
priestly wisdom, in magic, in the formulation of
wise proverbs, in medicine and architecture, this
remarkable figure of Zoser's reign left so notable
a reputation that his name was never forgotten,
and 2500 years after his death he had become a
God of Medicine, in whom the Greeks^ who called
him Imouthes, recognized their own ^sculapius."^
He became a popular god, not only healing men
when alive, but taking good care of them in the
journeys after death. The facts about this medi-
cince primus inventor, as he has been called, may be gathered from
Kurt Sethe's study.* He seems to have corresponded very much to
the Greek Asklepios. As a god he is met with comparatively late,
between 700 and 332 B. C. Numerous bronze figures of him remain.
The oldest memorial mentioning him is a statue of one of his priests,
Amasis (No. 14765 in the British Museum) . Ptolemy V dedicated to
him a temple on the island of Philae. His cult increased much in
later days, and a special temple was dedicated to him near Memphis.
Sethe suggests that the cult of Imhotep gave the inspiration to the
Hermetic literature. The association of Imhotep with the famous
temple at Edfu is of special interest.

Egypt became a centre from which civilization spread to the other

3 Breasted: A Histoiy of the Ancient Egyptians, Scribner, New Yoi-k, 1908, p. 104.

4 K. Sethe: Imhotep, der Asklepios der Aegypter, Leipzig, 1902 (Untersuchungen, etc., ed.
Sethe, Vol. II, No. 4,).

FIG. 3.
Imhotep.

EGYPTIAN MEDICINE 11

peoples of the Mediterranean. For long centuries, to be learned in all
the wisdom of the Egyptians meant the possession of all knowledge.
We must come to the land of the Nile for the origin of many of man's
most distinctive and highly cherished beliefs. Not only is there a
magnificent material civilization, but in records so marvellously pre-
served in stone we may see, as in a glass, here brightly, there darkly,
the picture of man's search after righteousness, the earliest im-
pressions of his moral awakening, the beginnings of the strife in
which he has always been engaged for social justice and for the
recognition of the rights of the individual. But above all, earlier and
more strongly than in any other people, was developed the faith that
looked through death, to which, to this day, the noblest of their
mopuments bear an enduring testimony. With all this, it is not
surprising to find a growth in the knowledge of practica,l medicine;
but Egyptian civilization illustrates how crude and primitive may
remain a knowledge of disease when conditioned by erroneous views .
of its nature. At first, the priest and physician were identified, and
medicine never became fully dissociated from religion. Qnly in the
later periods did a special group of physicians arise who were not
members of priestly colleges. ° Maspero states that the Egyptians \
believed that disease and death were not natural and inevitable, but
caused by some malign influence which could use any agency, natural
or invisible, and very often belonged to the invisible world. "Often,
though, it belongs to the invisible world, and only reveals itself by the
malignity of its attacks : it is a god, a spirit, the soul of a dead man,
that has cunningly entered a living person, or that throws itself upon
him with irresistible violence. Once in possession of the body, the
evil influence breaks the bones, sucks out the marrow, drinks the
blood, gnaws the intestines and the heart and devours the flesh. The
invalid perishes according to the progress of this destructive work;
and death speedily ensues, unless the evil genius can be driven out of
it before it has committed irreparable damage. Whoever treats a
sick person has therefore two equally important duties to perform.
He must first discover the nature of the spirit in possession, and, if
necessary, its name, and then attack it, drive it out, or even destroy
it. He can only succeed by powerful magic, so he must be an expert
in reciting incantations, and skilful in making amulets. He must then

5 Maspero: Life in Ancient Egypt and Assyria, London, 1891, p. 119.

12 THE EVOLUTION OF MODERN MEDICINE

use medicine [drugs and diet] to contend with the disorders which
the presence of the strange being has produced in the body.'"*

In this way it came about that diseases were believed to be due to
hostile spirits, or caused bj^ the anger of a god, so that medicines, no
matter how powerful, could only be expected to assuage the pain;
but magic alone, incantations, spells and prayers, could remove the
disease. Experience brought much of the wisdom we call empirical,
and the records, extending for thousands of j'^ears, show that the
^Egyptians employed emetics, purgatives, enemata, diuretics, diapho-
retics and even bleeding. They had a rich pharmacopoeia derived
from the animal, vegetable and mineral kingdoms. In the later
periods, specialism reached a remarkable development, and Herodotus
remarks that the country was full of physicians; — "One treats only
the diseases of the eye, another those of the head, the teeth, the abdo-
^ men, or the internal organs."

'' Our knowledge of Egyptian medicine is derived largely from the
remarkable papyri dealing specially with this subject. Of these, six
or seven are of the first importance. The most famous is that dis-
covered by Ebers, dating from
about 1500 B. C. A superb
^s.^'C^JiZ' document — one of the great
treasures of the Leipzig Library
m^^^u'^iv'^^Mt^^^Sy —'^ i«' in l^n^h, and is in a
tzl:l[ll3?%aSilSKlS '*^*^ °^ wonderful preservation.

'■v3X?i5^>fSr^Afi?i),£:^^l<«BT&U Others are the Kahun, Berlin,

^ii/^atilirJi^^jwS^zTiliff^s^-" Hearst and British Museum

Jff/^fg^^^fSVsS'&'Sffi papyri- All these have now

rAJ:?U-il4;iS£iJ]MU-Tl-^-[f.=^«:S ^jggv, rjublished the last three

k^r^Wsfl^a^ii/fi^iliS.^ti&iul^ puuiisiiea tne last tnree

ii*'[rza:'<»<'a5:''^/^^5r.i2L/Ar=ri2.Ur4>" quite recently, edited by Wres-

i^'T'i:^su.s--3Ltofed(il±332anf,<='-5 zinski. 1 show here a repro-

^^'Q^)3As^nA\^l!U][Mim^^.u auction from which an idea may

^'li-my.^r^l^klra-.is^r.^fL^ » be had of these remarkable docu-

ments. They are motley collec-

FiG. 4. tions, filled with incantations,

Beginning of Ebers Papyrus. charms, magical formulse, sym-

6 Maspero: Life in Ancient Egypt and Assyria, London, 1891, p. 118.

' W. Wreszinslci: Die Medizin der alten Aegypter, Leipzig, J. C. Hinrichs, 1909-1913.

EGYPTIAN MEDICINE 13

bols, prayers and prescriptions for all sorts of ailments. One is im-
pressed by the richness of the pharmacopoeia, and the high develop-
ment which the art of pharmacy must have attained. There were
gargles, salves, snuffs, inhalations, suppositories, fumigations, enem-
ata, poultices and plasters ; and they knew the use of opium, hemlock,
the copper salts, squills and castor oil. Surgery was not very highly
developed, but the knife and actual cautery were freely used. Oph-
thalmic surgery was practised by specialists, and there are many
prescriptions in the papyri for ophthalmia.

One department of Egyptian medicine reached a high stage of
development, viz., hygiene. Cleanliness of the dwellings, of the cities
and of the person was regulated by law, and the priests set a
splendid example in their frequent ablutions, shaving of the entire
body, and the spotless cleanliness of their clothing. As Diodorus
remarks, so evenly ordered was their whole manner of life that it was
as if arranged by a learned physician rather than by a lawgiver.

Two world-wide modes of practice found their earliest illustration
in ancient Egypt. Magic represented the attitude of primitive man
to nature, and really was his religion. He had no idea of immutable
laws, but regarded the world about him as changeable, and fickle like
himself, and "to make life go as he wished, he must be able to please
and propitiate or to coerce these forces outside himself."*

The point of interest to us is that in the Pyramid Texts — "the
oldiest chapter in human thinking preserved to us, the remotest reach
in the intellectual history of man which we are now able to discern"" —
one of their six-fold contents relates to the practice of magic. A deep
belief existed as to its efficacy, particularly in guiding the dead, who
were said to be glorious by reason of mouths equipped with the
charms, prayers and ritual of the Pyramid Texts, armed with which
alone could the soul escape the innumerable dangers and ordeals of
the passage through another world. And man has never lost his belief
in the efficacy of magic, in the widest sense of the term. Only a very
few of the most intellectual nations have escaped from its shackles.^
Nobody else has so clearly expressed the origins and relations of magic

sL. Thorndike: The Place of Magic in the Intellectual History of Europe, New York, 1905,
p. 39.

9 Breasted: Development of Religion and Thought in Ancient Egypt, New York, 1912, p. 84.

14 THE EVOLUTION OF MODERN MEDICINE

as Pliny in his "Natural Ilistory."^^ "Now, if a man consider the
thing well, no marvaile it is that it hath continued thus in so great
request and authoritie; for it is the onely Science which seemeth to
comprise in itselfe three possessions besides, which have the command
and rule of mans mind above any other whatsoever. For to begin
withall, no man doubteth but that Magicke tooke root first, and pro-
ceeded from Physicke, under the pretence of maintaining health,
curing, and preventing diseases: things plausible to the world, crept
and insinua-ted farther into the heart of man, with a deepe conceit of
some high and divine matter therein more than ordinarie, and in com-
parison whereof, all other Physicke was but basely accounted. And
having thus made way and entrance, the better to fortifie it selfe, and
to give a goodly colour and lustre to those fair and flattering promises
of things, which our nature is most given to hearken after, on goeth
the habite also and cloake of religion : a point, I may tell you, that even
in these daies holdeth captivate the spirit of man, and draweth away
with it a greater part of the world, and nothing so much. But not
content with this successe and good proceeding, to gather more
strength and win a greater name, shee entermingled with medicinable
receipts and religious ceremonies, the skill of Astrologie and arts
Mathematicall; -presuming upon this, That all men by nature are very
curious and desirous to know their future fortunes, and what shall
betide them hereafter, persuading themselves, that all such fore-
knowledge dependeth upon the course and influence of the starres,
which give the truest and most certain light of things to come. Being
thus wholly possessed of men, and having their senses and understand-
ing by this meanes fast ynough bound with three sure chains, no
marvell if this art grew in processe of time to such an head, that it was
and is at this day reputed by most nations of the earth for the paragon
and cheefe of all sciences : insomuch as the mightie Idngs and monarchs
of the Levant are altogether ruled and governed thereby."

The second world-wide practice which finds its earliest record
among the Egyptians is the use of the secretions and parts of the
animal body as medicine. The practice was one of great antiquity
with primitive man, but the papyri already mentioned contain the

10 The Historie of the World, commonly called the Naturall Historie of C. Plinlus Secundus,
translated into English by Philemon Holland, Doctor in Physicke, London, 1601, Vol. II,
p. 371, Bk. XXX, Chap. I, Sect. 1.

EGYPTIAN MEDICINE 15

earliest known records. Saliva, urine, bile, faeces, various parts of
the body, dried and powdered, worms, insects, snakes were important
ingredients in the pharmacopoeia. The practice became very wide-
spread throughout the ancient world. Its extent and importance
may be best gathered from chapters VII and VIII in the 28th book
of Pliny's "Natural History." Several remedies are mentioned as
derived from man; others from the elephant, lion, camel, crocodile,
and some seventy-nine are prepared from the hyaena. The practice
was widely prevalent throughout the Middle Ages, and the phai:inaco-
poeia of the seventeenth and even of the eighteenth cdntury contains
many extraordinary ingredients. "The Royal Pharmacopoeia" of
Moses Charras (London ed., 1678), the most scientific work of the
day, is full of organotherapy and directions for the preparation of
medicines from the most loathsome excretions. A curious thing is that
with the discoveries of the mummies a belief arose as to the great
efficacy of powdered mummy in various maladies. As Sir Thomas
Browne remarks in his "Urn Burial" : "Mummy has become merchan-
dize. Mizraim cures wounds, and Pharaoh is sold for balsams."

One formula in everyday use has come to us in a curious way from
the Egyptians. In the Osiris myth, the youthful Horus loses an
eye in his battle with Set. This eye, the symbol of sacrifice, became,
next to the sacred beetle, the most common talisman of the country,
and all museums are rich in models of the Horus eye in glass or stone.

"When alchemy or chemistry, which had its cradle in Egypt, and
derived its name from Khami, an old title for this country, passed
to the hands of the Greeks, and later of the Arabs, this sign passed
with it. It was also adopted to some extent by the Gnostics of the
early Christian church in Egypt. In a cursive form it is found in
mediaeval translations of the works of Ptolemy the astrologer, as
the sign of the planet Jupiter. As such it was placed upon horo-
scopes and upon formulae containing drugs made for administration
to the body, so that the harmful properties of these drugs might be
removed under the influence of the lucky planet. At present, in a
slightly modified form, it still figures at the top of prescriptions
written daily in Great Britain {^ ) .""

For centuries Egyptian physicians had a great reputation, and in

11 John D. Comrie: Medicine among the Assyrians and Egyptians in 1500 B. C, Edinburgh
Medical Journal, 1909, n. s., II, 119.

16 THE EVOLUTION OF MODERN MEDICINE

the Odyssey (Bk. IV), Polydamna, the wife of Thonis, gives medici-
nal plants to Helen in Egypt — "a country producing an infinite
number of drugs . . . where each physician possesses knowledge
above all other men." Jeremiah (xlvi, 11) refers to the virgin
daughter of Egypt, who should in vain use many medicines. Herod-
otus tells that Darius had at his court certain Egyptians, whom

vy

OGold; \JJ Copper; j^y Iron; /\

the Sun. Tp Venus. Qj Mj^s... {^

JJ Tin; JiL Lead; ([ Silver; V^

f Jupiter. I Saturn. II the Moon. ^/

Antimony ; \
no planet.

Mercury ;
Merciiry. :

FIG. 5.
Symbols representing both Metals and Heavenly Bodies.

he reckoned the best skilled physicians in all the world, and he makes
the interesting statement that: "Medicine is practiced among them on
a plan of separation; each physician treats a single disorder, and no
more : thus the country swarms with medical practitioners, some under-
taking to cure diseases of the eye, others of the head, others again of
the teeth, others of the intestines, and some those which are not
local.'"^

A remarkable statement is made by Plinjr, in the discussion upon
the use of radishes, which are said to cure a "Phthisicke," or ulcer of
the lungs — "proof e whereof was found and seen in iEgypt by occa-
sion that the KK. there, caused dead bodies to be cut up, and anato-
mies to be made, for to search out the maladies whereof men died.""

The study of the anatomy of mummies has thrown a very interest-
ing light upon the diseases of the ancient Egyptians, one of the most
prevalent of which appears to have been osteo-arthritis. This has been
studied by Elliot Smith, Wood Jones, Ruffer and Rietti. The ma-

12 The History of Herodotus, Blakesley's ed., Bk. II, 84.

13 Pliny, Bk. XIX, Oiap. V, Sect 26.

ASSYRIAN AND BABYLONIAN MEDICINE 17

jority of the lesions appear to have been the
common osteo-arthritis, which involved not
only the men, but many of the pet animals
kept in the temples. In a much higher pro-
portion apparently than in modern days, the
spinal column was involved. It is interesting
to note that the "determinative" of old age in
hieroglyphic writing is the picture of a man^
afflicted with arthritis deformans. Evidences
of tuberculosis, rickets and syphilis, according
to these authors, have not been found.

A study of the internal organs has been
made by Buffer, who has shown that arterio-
sclerosis with calcification was a common
disease 3500 years ago; and he holds that it
COUI4, not have been associated: with hard
.work or alcohol, for the ancient Egyptians

did not drink spirits, and they had practically the same hours of work

as modern Egyptians, with every seventh day free.

FIG. 6.

Mummy with Spinal

Curvature.

{Buffer.)

ASSYRIAN AND BABYLONIAN MEDICINE

Or equally great importance in the evolution of medicine was the
practically contemporary civilization in Mesopotamia. Science here
reached a much higher stage than in the valley of the Nile. An elabo-
rate scheme of the universe was devised, a system growing out of
the Divine Will, and a recognition for the first time of a law guiding
and controlling heaven and earth alike. Here, too, we find medicine
ancillary to religion. Disease was due to evil spirits or demons.
"These 'demons' — invisible to the naked eye^ — ^were the precursors of
the modern 'germs' and 'microbes,' while the incantations recited by
the priests are the early equivalents of the physician's prescriptions.
There were different incantations for different diseases; and they
were as mysterious to the masses as are the mystic formulas of the
modern physician to the bewildered, yet trusting, patient. Indeed,
their mysterious character added to the power supposed to reside in
the incantations for driving the demons away. Medicinal remedies

18 THE EVOLUTION OF MODERN MEDICINE

accompanied the recital of the incantations, but despite the consider-
able progress made by such nations of hoary antiquity as the Egyp-
tians and Babylonians in the diagnosis and treatment of common
diseases, leading in time to the development of an extensive pharma-
cology, so long as the cure of disease rested with the priests, the recital
of sacred formulas, together with rites that may be conveniently
grouped under the head of sympathetic magic, was regarded as
equally essential with the taking of the prescribed remedies.""

Three points of interest may be referred to in connection with
Babylonian medicine. Our first recorded observations on anatomy
are in connection with the art of divination — the study of the future
by the interpretation of certain signs. The student recognized two
divisions of divination — the involuntary, dealing with the interpreta-
tion of signs forced upon our attention, such as the phenomena of the
heavens, dreams, etc., and voluntary divination, the seeking of signs,
more particularly through the inspection of sacrificial animals. This
method reached an extraordinary development among the Baby-
lonians, and the cult spread to the Etruscans, Hebrews, and later
to the Greeks and Romans.

Of all the organs inspected in a sacrificial animal the liver, from its
size, position and richness in blood, impressed the early observers as
the most important of the body. Probably on account of the richness
in blood it came to be regarded as the seat of life — indeed, the seat of
the soul. From this important position the liver was not dislodged
for many centuries, and in the Galenic physiology it shared with the
heart and the brain in the triple control of the natural, animal and
vital spirits. Many expressions in literature indicate how persistent
was this belief. Among the Babylonians, the word "liver" was used
in hymns and other compositions precisely as we use the word "heart,"
and Jastrow gives a number of illustrations from Hebrew, Greek and
Latin sources illustrating this usage.

The belief arose that through the inspection of this important organ
in the sacrificial animal the course of future events could be predicted.
"The life or soul, as the seat of life, in the sacrificial animal is, there-
fore, the divine element in the animal, and the god in accepting the

14 Morris Jastrow: The Liver in Antiquity and the Beginnings of Anatomy. Transactions
College of Physicians, Philadelphia, 1907, 3. s., XXIX, 117-138.

ASSYRIAN AND BABYLONIAN MEDICINE 19

animal, which is involved in the act of bringing it as an offering to a
god, identifies himself with the animal — becomes, as it were, one with
it. The life in the animal is a reflection of his own life, and since the
fate of men rests with the gods, if one can succeed in entering into
the mind of a god, and thus ascertain what he purposes to do, the
key for the solution of the problem as to what the future has in store
will have been found. The liver being the centre of vitality — the seat
of the mind, therefore, as well as of the emotions — it becomes in the
case of the sacrificial animal, either directly identical with the mind
of the god who accepts the animal, or, at all events, a mirror in which
the god's mind is reflected; or, to use another figure, a watch regu-
lated to be in sympathetic and perfect accord with a second watch. If,
therefore, one can read the liver of the sacrificial animal, one enters,
as it were, into the workshop of the divine will."^°

Hepatoscopy thus became, among the Babylonians, of extraordi-
nary complexity, and the organ of the sheep was studied and figured
as early as 3000 B. C. In the divination rites, the lobes, the gall-
bladder, the appendages of the upper lobe and the markings were all
inspected with unusual care. The earliest known anatomical model,
which is here shown, is the clay model of a sheep's liver with the
divination text dating from about 2000 B. C, from which Jastrow
has worked out the modern anatomical equivalents of the Babylonian
terms. (Fig. 7.) To reach a decision on any point, the phenomena
of the inspection of the liver were carefully recorded, and the interpre-
tations rested on a more or less natural and original association of
ideas. Thus, if the gall-bladder were swollen on the right side, it
pointed to an increase in the strength of the King's army, and was
favorable ; if on the left side, it indicated rather success of the enemy,
and was unfavorable. If the bile duct was long, it pointed to a long
life. Gallstones are not infrequently mentioned in the divination
texts and might be favorable, or unfavorable. Various interpre-
tations were gathered by the scribes in the reference note-books which
serve as guides for the interpretation of the omens and for text-books
of instructions in the temple schools (Jastrow).

The art of divination spread widely among the neighboring
nations. There are many references in the Bible to the practice. The

15 Morris Jastrow: loc. cit., p. 123.

Clay Model of Sheep's Liver (Babylonian, circa 2000 B. C).

Bronze Model of Liver (Etruscan, circa Third Century B. C).

FIG. 7.
{From Jastrow.)

ASSYRIAN AND BABYLONIAN MEDICINE 21

elders of Moab and Midian came to Balaam 'Vith the rewards of
divination in their hand" (Numbers xxii, 7). Joseph's cup of divi-
nation was found in Benjamin's sack (Genesis xliv, 5, 12) ; and in
Ezekiel (xxi, 21) the King of Babylon stood at the parting of the

^^ = UR = Kabittu (Liver)

«i' BA=PantQ(Uver surface)

(Al/^JJ//J/i/^^►T^ ^- A^vnk (E)«.^<//r^ c^rr-ii./w//Y

Ayfou Aaoilft ia iumia \l)aCcAa cuson/s *~^ = na

\D)/o^us i^usaratui \^ dctus rspatxus t^^^V^^ c\«.-- nf>!^

{Jj)A/us cat/c»/i/i n^ P^^r = urmurob (K.I venaporlae RTliKAUAC-oo'/T'Tt/
^^ji/xvcesti/spyramfcaffj ^ ^^^l-su-si </Affv_[MI^«<* feme. umiJctxs

FIG. 8.

Diagram of Sheep's Liver, showing modern
anatomical terms and their Babylonian
equivalents.

{jastrow. )

way and looked in the liver. Hepatoscopy was practised extensively
by the Etruscans, and from them it passed to the Greeks and the
Romans, among whom it degenerated into a more or less meaningless
superstition. But Jastrow states that in Babylonia and Assyria,

22 THE EVOLUTION OF MODERN MEDICINE

where for several thousand years the liver was consistently employed
as the sole organ of divination, there are no traces of the rite having
fallen into decay, or having been abused by the priests.

In Roman times, Philostratus gives an account of the trial of
Apollonius of Tyana," accused of human hepatoscopy by sacrificing
a boy in the practice of magic arts against the Emperor. "The liver,
which the experts say is the very tripod of their art, does not consist
of pure blood; for the heart retains all the uncontaminated blood,
and irrigates the whole body with it by the conduits of the arteries;
whereas the gall, which is situated next the liver, is stimulated by
anger and depressed by fear into the hollows of the liver."

We have seen how early and how widespread was the belief in
amulets and charms against the occult powers of darkness. One that
has persisted with extraordinary tenacity is the belief in the Evil
Eye — the power of certain individuals to injure with a look. Of
general belief in the older civilizations, and referred to in several
places in the Bible, it passed to Greece and Rome, and today is still
held fervently in many parts of Europe. The sign of "le coma" the
first and fourth fingers extended, the others turned down and the
thumb closed over them, still used against the Evil Eye in Italy, was
a mystic sign used by the Romans in the festival of Lemuralia. And
we meet with the belief also in this country. A child with hemiplegia,
at the Infirmary for Diseases of the Nervous System, Philadelphia,
from the central part of Pennsylvania, was believed by its parents
to have had the Evil Eye cast upon it.

The second contribution of Babylonia and Assyria to medicine —
one that affected mankind profoundly — relates to the supposed influ-
ence of the heavenly bodies upon man's welfare. A belief that the
stars in their courses fought for or against him arose early in their
civilizations, and directly out of their studies on astrology and mathe-
matics. The Macrocosm, the heavens that "declare the glory of
God," reflect, as in a mirror, the Microcosm, the daily life of man on
earth. The first step was the identification of the sun, moon and
stars with the gods of the pantheon. Assyrian astronomifcal observa-
tions show an extraordinary development of practical knowledge.

16 Philostratus: Apollonius of Tyana, Bk. VIII, Chap. "VII, Phillimore's transl., Oxford,
1912, II, 333. See, also, Justin: Apologies, edited by Louis Pautigny, Paris, 1904, p. 39.

ASSYRIAN AND BABYLONIAN MEDICINE 23

The movements of the sun and moon and of the planets were studied ;
the Assyrians knew the precession of the equinoxes and many of the
fundamental laws of astronomy, and the modern nomenclature dates
from their work. The twelve constellations traced in the heavens
correspond practically with the signs of the zodiac — each division
represented by the symbol of some god, as the Scorpion, the Ram,
the Twins, etc. "Changes in the heavens . . . portended changes on
earth. The Biblical expression 'hosts of heaven' for the starry uni-
verse admirably reflects the conception held by the Babylonian as-
trologers. Moon, planets and stars constituted an army in constant
activity, executing military manceuvres which were the result of
deliberation and which had in view a fixed purpose. It was the func-
tion of the priest — the bdru, or 'inspector,' as the astrologer as well as
the 'inspector' of the liver was called — to discover this purpose. In
order to do so, a system of interpretation was evolved, less logical and
less elaborate than the system of hepatoscopy, which was analyzed in
the preceding chapter, but nevertheless meriting attention both as an
example of the pathetic yearning of men to peer into the minds of
the gods, and of the influence that Baby Ionian- Assyrian astrology
exerted throughout the ancient world" ( Jastrow) ."

With the rationalizing influence of the Persians the hold of astrol-
ogy weakened, and according to Jastrow it was this, in combination
with Hebrew and Greek modes of thought, that led the priests in the
three centuries following the Persian occupation, to exchange their
profession of diviners for that of astronomers ; and this, he says, marks
the beginning of the conflict between religion and science. At first an
expression of the science of the day, astrology became a superstition,
from which the human mind has not yet escaped. In contrast to
divination, astrology does not seem to have made much impression on
the Hebrews and definite references in the Bible are scanty. From
Babylonia it passed to Greece (without, however, — and this is a curi-
ous fact, — influencing Greek medicine) . Our own language is rich in
words of astral significance derived from the Greek, e.g., disaster.

The introduction of astrology into Europe has a passing interest.
Apparently the Greeks had made important advances in astronomy
before coming in contact with the Babylonians, — who, in all proba-

17 M. Jastrow: Aspects of Religious Belief and Practice in Babylonia and Assyria, New
York, 1911, p. 310.

24 THE EVOLUTION OF MODERN MEDICINE

bility, received from the former a scientific conception of the universe.
"In Babylonia and Assyria we have astrology first and astronomy
afterwards, in Greece we have the sequence reversed — astronomy
first and astrology afterwards" (Jastrow)/^

It is surprising to learn that, previous to their contact with the
Greeks, astrology as relating to the individual — that is to say, the
reading of the stars to determine the conditions under which the
individual was born — had no place in the cult of the Babylonians and
Assyrians. The individualistic spirit led the Greek to make his gods
take note of every action in his life, and his preordained fate might
be read in the stars. — "A connecting link between the individual and
the movements in the heavens was found in an element which they
shared in common. Both man and stars moved in obedience to forces
from which there was no escape. An inexorable law controlling the
planets corresponded to an equally inexorable fate ordained for every
individual from his birth. Man was a part of nature and subject to
its laws. The thought could therefore arise that, if the conditions
in the heavens were studied under which a man was born, that man's
future could be determined in accord with the beliefs associated with
the position of the planets rising or visible at the time of birth or,
according to other views, at the time of conception. These views take
us back directly to the system of astrology developed by Babylonian
bdru priests. The basis on which the modified Greek system rests
is likewise the same that we have observed in Babylonia — a corre-
spondence between heaven and earth, but with this important differ-
ence, that instead of the caprice of the gods we have the unalterable
fate controlling the entire universe — the movements of the heavens
and the life of the individual alike" ( Jastrow) ."

From this time on until the Renaissance, like a shadow, astrology
follows astronomy. Regarded as two aspects of the same subject,
the one, natural astrology, the equivalent of astronomy, was con-
cerned with the study of the heavens, the other, judicial astrology,
was concerned with the casting of horoscopes, and reading in the stars
the fate of the individual.

As I mentioned, Greek science in its palmy days seems to have
been very free from the bad features of astrology. Gilbert Murray

18 M. Jastrow: Aspects of Religious Belief and Practice In Babylonia and Assyria, New
York, 1911, p. 356.

19 Ibid., pp. 257-258.

ASSYRIAN AND BABYLONIAN MEDICINE 25

remarks that "astrologj^ fell upon the Hellenistic mind as a new
disease falls upon some remote island people." But in the Greek con-
quest of the Roman mind, astrology took a prominent role. It came
to Rome as part of the great Hellenizing movement, and the strength
of its growth may be gauged from the edicts issued against astrologers
as early as the middle of the second century B.C. In his introduction
to his recent edition of Book II of the Astronomicon of Manilius,
Garrod traces the growth of the cult, which under the Empire had
an extraordinary vogue. "Though these [heavenly] signs be far re-
moved from us, yet does he [the god] so make their influences felt, that
they give to nations their life and their fate and to each man his own
character."^" Oracles were sought on all occasions, from the planting
of a tree to the mating of a horse, and the doctrine of the stars influ-
enced deeply all phases of popular thought and religion. The pro-
fessional astrologers, as Pliny" says, were Chaldeans, Egyptians and
Greeks. The Etruscans, too, the professional diviners of Rome, cul-
tivated the science. Many of these "Isiaci conjectores" and "astrol-
ogi de circo" were worthless charlatans, but on the whole the science
seems to have attracted the attention of thoughtful men of the period.
Garrod quotes the following remarkable passage from Tacitus: "My
judgment wavers," he says, "I dare not say whether it be fate and
necessity immutable which governs the changing course of human
affairs — or just chance. Among the wisest of the ancients, as well
as among their apes, you will find a conflict of opinion. Many hold
fixedly the idea that our beginning and our end — that man himself —
is nothing to the Gods at all. The wicked are in prosperity and the
good meet tribulation. Others believe that Fate and the facts of this
world work together. But this connection they trace not to planetary
influences but to a concatenation of natural causes. We choose our
life — that is free: but the choice once made, what awaits us is fixed
and ordered. Good and evil are different from the vulgar opinion of
them. Often those who seem to battle with adversity are to be ac-
counted blessed ; but the many, even in their prosperity, are miserable.
It needs only to bear misfortune bravely, while the fool perishes in
his wealth. Outside these rival schools stands the man in the street.
No one will take from him his conviction that at our birth are fixed f or

20 Manili Astronomicon Liber II, ed. H. W. Garrod, Oxford, 1911, p. Ixix, and II, 11. 84-86.

21 Pliny: Natural History, Bk. XVIII, Chap. XXV, Sect. 57.

FIG. 9.

Code Hammurabi (circa 2000 B. C. ).

(Harper.)

ASSYRIAN AND BABYLONIAN MEDICINE 27

us the things that shall be. If some things fall out differently from
what was foretold, that is due to the deceit of men that speak what
they know not: calling into contenipt a science to which past and
present alike bear a glorious testimony" (Ann. vi, 22) .

Cato waged war on the Greek physicians and forbade "his uilicus
all resort to haruspicem, augur em, hariolum Chaldceum" ; but in vain,
so widespread became the belief that the great philosopher, Pansetius
(who died about 111 B. C), and two of his friends alone among the
stoics, rejected the claims of astrology as a science (Garrod). So
closely related was the subject of mathematics that it, too, fell into
disfavor and in the Theodosian code, sentence of death was passed
upon mathematicians. Long into the Middle Ages, the same unholy
alliance with astrology and divination caused mathematics to be
regarded with suspicion, and even Abelard calls it a nefarious study.

The third important feature in Babylonian medicine is the evidence
afforded by the famous Hammurabi Code {circa 2000 B. C.) — a body
of laws, civil and religious, many of which relate to the medical pro-
fession. This extraordinary document (Fig. 9) is a black diorite
block 8 feet high, once containing 21 columns on the obverse, 16 and
28 columns on the reverse, with 2540 lines of writing of which now
1114 remain, and surmounted by the figure of the king receiving the
law from the Sun-god. Copies of this were set up in Babylon "that
anyone oppressed or injured, who had a tale of woe to tell, might
come and stand before his image; that of a king of righteousness, and
there read the priceless orders of the King, and from the written
monument solve his problem" (Jastrow). From the enactments of
the code we gather that the medical profession must have been in a /
highly organized state, for not only was practice regulated in detail,
but a scale of fees was laid down, and penalties exacted for malpraxis.
Operations were performed, and the veterinary art was recognized.
An interesting feature, from which it is lucky that we have in these
days escaped, is the application of the "lex talionis" — an eye for an
eye, bone for a bone, and tooth for a tooth, which is a striking feature
of the code.

Some of the laws of the code may be quoted :

Paragraph 215. If a doctor has treated a gentleman for a severe wound
with a bronze lancet and has cured the man, or has opened an abscess of the eye

28 THE EVOLUTION OF MODERN MEDICINE

for a gentleman with the bronze lancet and has cured the eye of the gentleman,
he shall take ten shekels of silver.

218. If the doctor has treated a gentleman for a severe wound with a
lancet of bronze and has caused the gentleman to die, or has opened an abscess
of the eye for a gentleman and has caused the loss of the gentleman's eye, one
shall cut off his hands.

219. If a doctor has treated the severe wound of a slave of a poor man
with a bronze lancet and has caused his death, he shall render slave for slave.

220. If he has opened his abscess with a bronze lancet and has made him
lose his eye, he shall pay money, half his price.

221. If a doctor has cured the shattered limb of a gentleman, or has cured
the diseased bowel, the patient shall give five shekels of silver to the doctor.

224. If a cow doctor or a sheep doctor has treated a cow or a sheep for
a severe wound and cured it, the owner of the cow or sheep shall give one-sixth
of a shekel of silver to the doctor as his fee.^^

HEBREW MEDICINE

The medicine of the Old Testament betrays both Egyptian and Baby-
lonian influences; the social hygiene is a reflex of regulations the
origin of which may be traced in the Pyramid Texts and in the papyri.
The regulations in the Pentateuch codes revert in part to primitive
times, in part represent advanced views of hygiene. There are doubts
if the Pentateuch code really goes back to the days of Moses, but cer-
tainly someone "learned in the wisdom of the Egyptians" drew it up.
As Neuburger briefly summarizes :

"The commands concern prophylaxis and suppression of epidemics,
suppression of venereal disease and prostitution, care of the skin,
baths, food, housing and clothing, regulation of labour, sexual life,
discipline of the people, etc. Many of these commands, such as
Sabbath rest, circumcision, laws concerning food (interdiction of
blood and pork), measures concerning menstruating and lying-in
women and those suffering from gonorrhoea, isolation of lepers, and
hygiene of the camp, are, in view of the conditions of the climate,
surprisingly rational."^'

Divination, not very widely practised, was borrowed, no doubt,
from Babylonia. Joseph's cup was used for the purpose, and in

22 The Oldest Code of Laws in the World; translated by C. H. W. Johns, Edinburgh, 1903.

23 Neuburger: History of Medicine, Oxford University Press, 1910, Vol. I, p. 38.

HEBREW MEDICINE 29

Numbers, the elders of Balak went to Balaam with the rewards of
divination in their hands. The belief in enchantments and witchcraft
was universal, and the strong enactments against witches in the Old
Testament made a belief in them almost imperative until more rational
beliefs came into vogue in the eighteenth and nineteenth centuries.

Whatever view we may take of it, the medicine of the New Testa-
ment is full of interest. Divination is only referred to once in the
Acts (xvi, 16), where a damsel is said to be possessed of a spirit of
divination "which brought her masters much gain by soothsaying."
There is only one mention of astrology (Acts vii, 43) ; there are no
witches, neither are there charms or incantations. The diseases men-
tioned are numerous: demoniac possession, convulsions, paralysis,
skin diseases, — as leprosy, — dropsy, haemorrhages, fever, fluxes, blind-
ness and deafness. And the cure is simple — usually a fiat of the Lord,
rarely with a prayer, or with the use of means such as spittle. They
are all miraculous, and the same power was granted to the apostles —
"power against unclean spirits, to cast them out, to heal all manner of
sickness and all manner of disease." And more than this, not only the
blind received their sight, the lame walked, the lepers were cleansed,
the deaf heard, but even the dead were raised up. No question of the
mandate. He who went about doing good was a physician of the
body as well as of the soul, and could the rich promises of the Gospel
have been fulfilled, there would have been no need of a new dispensa-
tion of science. It may be because the children of this world have
never been able to accept its hard sayings — the insistence upon pov-
erty, upon humility, upon peace — that Christianity has lost touch no
less with the practice than with the principles of its Founder. Yet,
all through the centuries, the Church has never wholly abandoned the
claim to apostolic healing; nor is there any reason why she should.
To the miraculous there should be no time limit — only conditions have
changed and nowadays to have a mountain-moving faith is not easy.
Still, the possession is cherished, and it adds enormously to the spice
and variety of life to know that rrien of great intelligence, for example,
my good friend. Dr. James J. Walsh of New York, believe in the
miracles of Lourdes." Only a few weeks ago, the Bishop of London
followed with great success, it is said, the practice of St. James. It

2* Psychotherapy, New York, 1912, p. 79, "I am convinced that miracles happen there.
There is more than natural power manifest."

30 THE EVOLUTION OF MODERN MEDICINE

does not really concern us much — as Oriental views of disease and its
cure have had very little influence on the evolution of scientific medi-
cine — except in illustration of the persistence of an attitude towards
disease always widely prevalent, and, indeed, increasing. Nor can
we say that the medicine of our great colleague, St. Luke, the Beloved
Physician, whose praise is in the Gospels, differs so fundamentally
from that of the other writings of the New Testament that we can
claim for it a scientific quality. The stories of the miracles have tech-
nical terms and are in a language adorned by medical phraseology,
but the mental attitude towards disease is certainly not that of a fol-
lower of Hippocrates, nor of a scientifically trained contemporary
of Dioscorides.^^

CHINESE AND JAPANESE MEDICINE

Chinese medicine illustrates the condition at which a highly intellec-
tual people may arrive, among whom thought and speculation were
restricted by religious prohibitions. Perhaps the chief interest in its
study lies in the fact that we may see today the persistence of views
about disease similar to those which prevailed in ancient J^ypt and
Babylonia. The Chinese believe in a universal animism, all parts
being animated by gods and spectres, and devils swarm everywhere
in numbers incalculable. The universe was spontaneously, created by
the operation of its Tao, "composed of two souls, the Yang and the
Yin; the Yang represents light, warmth, production, and life, as also
the celestial sphere from which all those blessings. emanate; the Yin is
darkness, cold, death, and the earth, which, unless animated by the
Yang or heaven, is dark, cold, dead. The Yang and the Yin are
divided into an infinite number of spirits respectively good and bad,
called shen and kwei; every man and every living being contains a
shen and a kwei, infused at birth, and departing at death, to return to
the Yang and the Yin. Thus man with his dualistic soul is a micro-
cosmos, born from the Macrocosmos spontaneously. Even every ob-
ject is animated, as well as the Universe of which it is a part.'""

In the animistic religion of China, the Wu repres'ented a group of

25 See Luke the Physician, by Harnack, English ed., 1907, and W. K. Hobart, The Medical
Language of St. Luke, 1882.

26 J. J. M. de Groot: Religious System of China, Vol. VI, Leyden, 1910, p. 929.

CHINESE AND JAPANESE MEDICINE 31

persons of both sexes, who wielded, with respect to the world of
spirits, capacities and powers not possessed by the rest of men. Many
practitioners of Wu were physicians who, in addition to charms and
enchantments, used death-banishing medicinal herbs. Of great antiq-
uity, Wu-ism has changed in some ways its outward aspect, but has
not altered its fundamental characters. The Wu, as exorcising physi-
cians and practitioners of the medical art, may be traced in classical
literature to the time of Confucius. In addition to charms and spells,
there were certain famous poems which were repeated, one of which,
by Han Yii, of the T'ang epoch, had an extraordinary vogue. De
Groot says that the "Ling," or magical power of this poem must
have been enormous, seeing that its author was a powerful mandarin,
and also one of the loftiest intellects China has produced. This poetic
febrifuge is translated in full by de Groot (VI, 1054-1055), and the
demon of fever, potent chiefly in the autumn, is admonished to begone
to the clear and limpid waters of the deep river.

In the High Medical College at Court, in the T'ang Dynasty, there
were four classes of Masters, attached to its two High Medical Chiefs :
Masters of Medicine, of Acupuncture, of Manipulation, and two
Masters for Frustration by means of Spells.

Soothsaying and exorcism may be traced far back to the fifth and
sixth centuries B. C.

In times of epidemic the specialists of Wu-ism, who act as seers,
soothsayers and exorcists, engage in processions, stripped to the waist,
dancing in a frantic, delirious state, covering themselves with blood by
means of prick-balls, or with needles thrust through their tongues,
or sitting or stretching themselves on nail points or rows of sword
edges. In this way they frighten the spectres of disease. They are
nearly all young, and are spoken of as "divining youths," and they
use an exorcising magic based on the principle that legions of spectres
prone to evil live in the machine of the world. (De Groot, VI, 983-985. )

The Chinese believe that it is the Tao, or "Order of the Universe,"
which affords immunity from evil, and according to whether the birth
occurred in a beneficent j^ear, dominated by four double cyclical char-
acters or not, the horoscope is "heavy" or "light." Those with light
horoscopes are specially prone to incurable complaints, but much
harm can be averted if such an individual be surrounded with exor-
cising objects, if he be given proper amulets to wear and proper

32 THE EVOLUTION OF MODERN MEDICINE

medicines to swallow, and by selecting for him auspicious days and
hours.

Two or three special points may be referred to. The doctrine of
the pulse reached such extraordinary development that the whole

620 A. D.

1920 A. D.

FIGS. 10 AND 11.

Chinese acupuncture diagrams, showing the maintenance of

tradition for 1300 years (620 A. D.-1920 A. D.).

{Courtesy qf Dr. E. V. Cotcdry, Peking, China.)

practice of the art centred round its different characters. There
were scores of varieties, which in complication and detail put to con-
fusion the complicated system of some of the old Grseco-Roman
writers. The basic idea seems to have been that each part and organ
had its own proper pulse, and just as in a stringed instrument each
chord has its own tone, so in the human bodj^ if the pulses were in

CHINESE AND JAPANESE MEDICINE 33

harmony, it meant health; if there was discord, it meant disease.
These Chinese views reached Europe in the seventeenth and eighteenth
centuries, and there is a very elaborate description of them in Floyer's
well-known book." And the idea of harmony in the pulse is met with
unto the eighteenth century.

Organotherapy was as extensively practised in China as in Egypt.
Parts of organs, various secretions and excretions are very commonly
used. One useful method of practice reached a remarkable develop-
ment, viz., the art of acupuncture — the thrusting of fine needles more
or less deeply into the affected part. There are some 388 spots on
the body in M^hich acupuncture could be performed (Figs. 10 and 11) ,
and so well had long experience taught them as to the points of
danger, that the course of the arteries may be traced by the tracts that
are avoided. The Chinese practised inoculation for smallpox as early 5^
as the eleventh century.

Even the briefest sketch of the condition of Chinese medicine leaves
the impression of the appalling stagnation and sterility that may
afflict a really intelligent people for thousands of years. It is doubt-
ful if they are today in a very much more advanced condition than
were the Egyptians at the time when the Ebers Papyrus was written.
From one point of view it is an interesting experiment, as illustrating
the state in which a people may remain who have no knowledge of
anatomj^ phj^siology or pathology.

Early Japanese medicine has not much to distinguish it from the
Chinese. At first purely theurgic, later acupuncture and a refined
study of the pulse characterized the practice. It has an extensive
literature, largely based upon the Chinese, and extending as far back
as the beginning of the Christian era. European medicine was intro-
duced by the Portuguese and the Dutch, the physicians to whose
factories were not without influence upon practice. An extraordinary
stimulus was given to the belief in European medicine by a dissection
made by Mayeno in 1771 demonstrating the position of the organs
as shown in the European anatomical tables, and proving the Chinese
figures to be incorrect. The next day a translation into Japanese
of the anatomical work of Kulmus was begun, and from its appear-
ance in 1773 may be dated the commencement of reforms in medicine.
In 1793, the work of de Gorter on internal medicine was translated,

27 Sir John Floyer: The Physician's Pulse Watch, etc., London, 1707.

34 THE EVOLUTION OF MODERN MEDICINE

and it is interesting to know that before the so-called "opening of
Japan" many European works on medicine had been published. In
1857, a Dutch medical school was started in Yedo. Since the political
upheaval in 1868, Japan has made rapid progress in scientific medi-
cine, and its institutions and teachers are now among the best known
in the world.^^

28 See Y. Fujikawa, Geschichte der Mediziii in Japan, Tokyo, 1911.

o

CHAPTER II

GREEK MEDICINE

GRAI^ gentis decus! let us sing with Lucretius, one of the
great interpreters of Greek thought. How grand and how
true is his psean !

Out of the night, out of the blinding night
Thy beacon flashes ; — hail, beloved light
Of Greece and Grecian; hail, for in the mirk
Thou dost reveal each valley and each height.

Thou art my leader, and the footprints thine.
Wherein I plant my own. . . .

* * * » »

The world was thine to read, and having read.
Before thy children's eyes thou didst outspread
The fruitful page of knowledge, all the wealth
Of wisdom, all her plenty for their bread.

[Bk. III.— Translated by D. A. Slater.]

Let us come out of the murky night of the East, heavy with phan-
toms, into the bright dayhght of the West, into the company of men
whose thoughts made our thoughts, and whose ways made our ways —
the men who first dared to look on nature with the clear eyes of the
mind. Browning's famous poem, "Childe Roland to the Dark Tower
Came," is an allegory of the pilgrimage of man through the dark
places of the earth, on a dismal path beset with demons, and strewn
with the wreckage of generations of failures. In his ear tolled the
knell of all the lost adventurers, his peers, all lost, lost within sight of
the dark Tower itself —

The round squat turret, blind as the fool's heart.
Built of brown stone, without a counterpart
In the whole world.

36 THE EVOLUTION OF MODERN MEDICINE

lost in despair at an all-encircling mystery. Not so the Greek Childe
Roland who set the slug-horn to his lips and blew a challenge.
Neither Shakespeare nor Browning tells us what happened, and the
old legend, Childe Roland, is the incarnation of the Greek spirit,
the young, light-hearted master of the modern world, at whose
trumpet blast the dark towers of ignorance, superstition and deceit
have vanished into thin air, as the baseless fabric of a dream. Not that
the jeering phantoms have flown! They still beset, in varied form, the
path of each generation; but the Achaian Childe Roland gave to
man self-confidence, and taught him the lesson that nature's mysteries,
to be solved, must be challenged. On a portal of one of the temples
of Isis in Egj'^pt was carved: "I am whatever hath been, is, or ever will
be, and my veil no man has yet lifted."

The veil of nature the Greek lifted and herein lies his value to us.
What of this Genius? How did it arise among the peoples of the
iEgean Sea? Those who wish to know the rock whence science was
hewn may read the story told in vivid language by Professor Gomperz
in his "Greek Thinkers," the fourth volume of which has recently been
published (Murray, 1912; Scribner, 1912). In 1912, there was pub-
lished a book by one of the younger Oxford teachers, "The Greek
Genius and Its Meaning t^Us,"^ from which those who shrink from
the serious study of Gomperz' four volumes may learn something of
the spirit of Greece. Let me quote a few lines from his introduction :

"Europe has nearly four million square miles; Lancashire has
1,700; Attica has 700. Yet this tinj^ country has given us an art
which we, with it and all that the world has done since it for our
models, have equalled perhaps, but not surpassed. It has given us
the staple of our vocabulary in every domain of thought and knowl-
edge. Politics, tyranny, democracy, anarchism, philosophy, physiol-
ogy, geology, history — these are all Greek words. It has seized and
up to the present day kept hold of our higher education. It has
exercised an unfailing fascination, even on minds alien or hostile.
Rome took her culture thence. Young Romans completed their
education in the Greek schools. . . . And so it was with natures less
akin to Greece than the Roman. St. Paul, a Hebrew of the Hebrews,
who called the wisdom of the Greeks foolishness, was drawn to their
Areopagus, and found himself accommodating his gospel to the

iBy R. W. Livingstone, Clarendon Press, Oxford, 1913 [2d ed., revised, 1915].

GREEK MEDICINE 37

style, and quoting verses from the poets of this alien race. After
him, the Church, which was born to protest against Hellenism, trans-
lated its dogmas into the language of Greek thought and finally
crystallized them in the philosophy of Aristotle."

Whether a plaything of the gods or a cog in the wheels of the imi-
verse — this was the problem which life offered to the thinking Greek ;
and in undertaking its solution, he set in motion the forces that have
made our modern civilization. That the problem remains unsolved
is nothing in comparison with the supreme fact that in wrestling with
it, and in studying the laws of the machine, man is learning to control
the small section of it with which he is specially concerned. The veil
of thaumaturgy which shrouded the Orient, while not removed, was
rent in twain, and for the first time in history, man had a clear vision
of the world about him — "had gazed on Nature's naked loveliness"
("Adonais") unabashed and unaff righted by the supei'natural powers
about him. Not that the Greek got rid of his gods — far from it! but
he made them so like himself, and lived on terms of such familiarity
with them that they inspired no terror.^

Livingstone discusses the Greek Genius as displayed to us in cer-
tain "notes" — the Note of Beauty — the Desire for Freedom — the
Note of Directness — the Note of Humanism — the Note of Sanity and
of Many-sidedness. Upon some of these characteristics we shall have
occasion to dwell in the brief sketch of the rise of scientific medicine
among this wonderful people.

We have seen that in the primitive man and in the great civiliza-
tions of Egj'^pt and Babylonia, the physician evolved from the priest —
in Greece he had a dual origin, philosophy and religion. Let us first
trace the origins in the philosophers, particularly in the group known
as the Ionian Physiologists, whether at home or as colonists in the
south of Italy, in whose work the beginnings of scientific medicine
may be found. Let me quote a statement from Gomperz :

2 "They made deities in their own image, in the likeness of an image of corruptible man.
Sua cuique deus fit dira cupido. 'Each man's fearful passion becomes his god.' Yes, and not
passions only, but every impulse, every aspiration, every humour, every virtue, every whim.
In each of his activities the Greek found something wonderful, and called it God: the hearth
at which he warmed himself and cooked his food, the street in which his house stood, the horse
he rode, the cattle he pastured, the wife he married, the child that was born to him, the plague
of which he died or from which he recovered, each suggested a deity, and he made one to
preside over each. So too with qualities and powers more abstract." R. W. Livingstone:
The Greek Genius and Its Meaning to Us, pp. 51-52.

i

38 THE EVOLUTION OF MODERN MEDICINE

"We can trace the springs of Greek success achieved and main-
tained by the great men of Hellas on the field of scientific inquiry to
a remarkable conjunction of natural gifts and conditions. There
was the teeming wealth of constructive imagination united with the
sleepless critical spirit which shrank from no test of audacity; there
was the most powerful impulse to generalization coupled with the
sharpest faculty for descrying and distinguishing the finest shades
of phenomenal peculiarity; there was the religion of Hellas, which
afforded complete satisfaction to the requirements of sentiment, and
yet left the intelligence free to perform its destructive work; there
were the political conditions of a number of rival centres of intellect,
of a friction of forces, excluding the possibility of stagnation, and,
finally, of an order of state and society strict enough to curb the
excesses of 'children crying for the moon,' and elastic enough
not to hamper the soaring flight of superior minds. . . . We have
already made acquaintance with two of the sources from which the
spirit of criticism derived its nourishment — -the metaphysical and
dialectical discussions practised by the Eleatic pliilosophers, and the
semi -historical method which was applied to the myths by Hecatsus
and Herodotus. A third source is to be traced to the schools of the
physicians. These aimed at eliminating the arbitrary element from
the view and knowledge of nature, the beginnings of which were
bound up with it in a greater or less degree, though practically with-
out exception and by the force of an inner necessity. A knowledge
of medicine was destined to correct that defect, and we shall mark the
growth of its most precious fruits in the increased power of observa-
tion and the counterpoise it offered to hasty generalizations, as well
as in the confidence which learnt to reject untenable fictions, whether
produced by luxuriant imagination or by a jjriori speculations, on
the similar ground of self-reliant sense-perception.""

The nature philosophers of the Ionian days did not contribute
much to medicine proper, but their spirit and their outlook upon
nature influenced its students profoundly. Their bold generalizations
on the nature of matter and of the elements are still the wonder of
chemists. We may trace to one of them, Anaximenes, who regarded
air as the primary principle, the doctrine of the "pneuma," or the
breath of life — the psychic force which animates the body and leaves

3 Gomperz: Greek Thinkers, Vol. I, p. 276.

GREEK MEDICINE 39

it at death — "Our soul being air, holds us together." Of another, the
famous Heraclitus, possibly a physician, the existing fragments do
not relate specially to medicine; but to the philosopher of fire may
be traced the doctrine of heat and moisture, and their antitheses, which
influenced practice for many centuries, and there is evidence in the
Hippocratic writings of the attempt to apply this doctrine to the
human body. The famous expression, panta rei, — "all things are
flowing," — expresses the incessant flux in which he believed and in
which we know all matter exists. No one has said a ruder thing of the
profession, for an extant fragment reads: "... physicians, who cut,
burn, stab, and rack the sick, then complain that they do not get any
adequate recompense for it."*

The South Italian nature philosophers contributed much more
to the science of medicine, and in certain of the colonial towns there
were medical schools as early as the fifth century B. C. The most
famous of these physician philosophers was Pythagoras, whose life
and work had an extraordinary influence upon medicine, particularly
in connection with his theory of numbers, and the importance of
critical days. His discovery of the dependence of the pitch of sound
on the length of the vibrating chord is one of the most fundamental
in acoustics. Among the members of the school which he founded at
Crotona were many physicians, who carried his views far and wide
throughout Magna Grsecia. Nothing in his teaching dominated medi-
cine so much as the doctrine of numbers, the sacredness of which seems
to have had an enduring fascination for the medical mind. Many
of the common diseases, such as malaria, or typhus, terminating
abruptly on special days, favored this belief. How dominant it
became and how persistent you may judge from the literature upon
critical days, which is rich to the middle of the eighteenth century.

One member of the Crotonian school, Alcmseon, achieved great dis-
tinction in both anatomy and physiology. He first recognized the
brain as the organ of the mind, and made careful dissections of the
nerves, which he traced to the brain. He described the optic nerves
and the Eustachian tubes, made correct observations upon vision,
and refuted the common view that the sperma came from the spinal
cord. He suggested the definition of health as the maintenance of
equilibrium, or an "isonomy" in the material qualities of the body.

* J. Burnet: Early Greek Philosophy, 1893, p. 137, Bywater's no. LVIII.

40 THE EVOLUTION OF MODERN MEDICINE

Of all the South Italian physicians of this period, the personality
of none stands out in stronger outlines than that of Empedocles of
Agrigentum — physician, phj^siologist, religious teacher, politician and
poet. A wonder-worker, also, and magician, he was acclaimed in the
cities as an immortal god by countless thousands desiring oracles or
begging the word of healing. That he was a keen student of nature

FIG. I'i.
Alcnifton.

is witnessed by many recorded observations in anatomy and physiol-
ogy; and in physics he had the rare distinction of discovering that
light travels; but our attention must be confined to his introduction
of the theory of the four elements — fire, air, earth and water — of
which, in varying quantities, all bodies were made up. Health de-
pended upon the due equilibrium of these primitive substances; dis-
ease was their disturbance. Corresponding to those were the four
essential qualities of heat and cold, moisture and dryness, and upon
this four-fold division was engrafted by the later physicians the doc-

GREEK MEDICINE 41

trine of the humors which, from the days of Hippocrates almost to
our own, dominated medicine. All sorts of magical powers were
attributed to Empedocles. The story of Pantheia whom he called
back to life after a thirty days' trance has long clung in the imagina-
tion. You remember how Matthew Arnold describes him in the
well-known poem, "Empedocles on Etna" —

But his power
Swells with the swelling evil of this time,
And holds men mute to see where it will rise.
He could stay swift diseases in old days,
Chain madmen by the music of his lyre,
Cleanse to sweet airs the breath of poisonous streams.
And in the mountain-chinks inter the winds.
This he could do of old — ^

a quotation which will give you an idea of some of the powers attribu-
ted to this wonder-working physician.

But of no one of the men of this remarkable circle have we such '
definite information as of the Crotonian physician Democedes, whose
story is given at length by Herodotus ; and his story has also the great
importance of showing that, even at this early period, a well-devised
scheme of public medical service existed in the Greek cities. It dates
from the second half of the sixth century B. C. — fully two generations
before Hippocrates. A Crotonian, Democedes by name, was found
among the slaves of Oroetes. Of his fame as a physician someone
had heard and he was called in to treat the dislocated ankle of King
Darius. The wily Greek, longing for his home, feared that if he
confessed to a knowledge of medicine there would be no chance of
escape, but under threat of torture he undertook a treatment which
proved successful. Then Herodotus tells his story — how, ill treated
at home in Crotona, Democedes went to ^gina, where he set up as a
physician and in the second year the State of iEgina hired his services
at the price of a talent. In the third year, the Athenians engaged him
at 100 minaj; and in the fourth, Polycrates of Samos at two talents.
Democedes shared the misfortunes of Polycrates and was taken
prisoner by Orcetes. Then Herodotus tells how he cured Atossa, the
daughter of Cyrus and wife of Darius, of a severe abscess of the

= Poetical Works of Matthew Arnold, Macmillan & Co., 1898, p. 440.

42 THE EVOLUTION OF MODERN MEDICINE

breast, but on condition that she help him to escape, and she induced
her husband to send an expedition of exploration to Greece under
the guidance of Democedes, but with the instructions at all costs to
bring back the much prized physician. From Tarentum, Democedes
escaped to his native city, but the Persians followed him, and it was
with the greatest difficulty that he escaped from their hands. De-
prived of their guide, the Persians gave up the expedition and sailed
for Asia. In palliation of his flight, Democedes sent a message to
Darius that he was engaged to the daughter of Mile, the wrestler,
who was in high repute with the King.*

Plato has several references to these state physicians, who were
evidently elected by a public assembly: "When the assembly meets
to elect a physician," and the office was yearlj^, for in "The States-
man" we find the following:^ "When the year of office has expired, the
pilot, or physician has to come before a court of review" to answer
any charges. The physician must have been in practice for some
time and attained eminence, before he was deemed worthy of the
post of state physician.

"If you and I were physicians, and were advising one another that
we were competent to practice as state-physicians, should I not ask
about you, and would you not ask about me. Well, but how about
Socrates himself, has he good health? and was anyone else ever known
to be cured by him whether slave or freeman?"™

8 The well-known editor of Herodotus, R. W. Macan, Master of University College, Oxford,
in his Sheaf of Sonnets, Hellenikon (Oxford, 1893), has included a poem which may be quoted
in connection with this incident:

NOSTALGY

Atossa, child of Cyrus, king of kings,

Healed by Greek science of a morbid breast,

Gave lord Dareios neither love nor rest

Till he fulfilled her vain imaginings.

"Sir, show our Persian folk your sceptre's wings.

Enlarge my sire's and brother's large bequest.

This learned Greek shall guide your galleys west,

And Dorian slave-girls grace our banquetings."

So said she, taught of that o'er-artful man.

The Italiote captive, Kroton's Demokede,

Who recked not what of maladies began.

Nor who in Asia and in Greece might bleed,

If he — so writes the guileless Thurian —

Regained his home, and freedom of the Mede.

7 Jowett: Dialogues of Plato, 3d ed.. Statesman, Vol. IV, p. 503 (Stephanus, II, 298 E).
raJowett: Dialogues of Plato, 3d ed., Gorgias, Vol. II, p. 407 (Stephanus, I, 514 D).

ASKLEPIOS 43

All that is known of these state physicians has been collected by'^
Pohl,^ who has traced their evolution into Roman times. That they
were secular, independent of the iEsculapian temples, that they were
well paid, that there was keen competition to get the most distin-
guished men, that they were paid by a special tax and that they were
much esteemed — are facts to be gleaned from Herodotus and from
the inscriptions. The lapidary records, extending over 1000 years,
collected by Professor Oehler*^ of Reina, throw an important light
on the state of medicine in Greece and Rome. On vases are represen-
tations of these state doctors at work. Dt. E. Pettier has published
one showing the treatment of a patient^probably bleeding.

That dissections were practised by this group of nature philoso-
phers is shown not only by the studies of Alcmseon, but we have evi-
dence that one of the latest of them, Diogenes of ApoUonia, must have
made elaborate dissections. In the "Historia Animalium"' of Aris-
totle occurs his account of the blood vessels, which is by far the most
elaborate met with in the literature until the writings of Galen. It
has, too, the great merit of accuracy (if we bear in mind the fact that
it was not until after Aristotle that arteries and veins were differen-
tiated), and indications are given as to the vessels from which blood
may be drawn.

ASKLEPIOS

No God made with hands, to use the scriptural phrase, had a more
successful "run" than Asklepios — for more than a thousand years
the consoler and healer of the sons of men. Shorn of his divine attri-
butes he remains our patron saint, our emblematic God of Healing,
whose figure with the serpents appears in our seals and charters. He
was originally a Thessalian chieftain, and fought in the Trojan War,
and his sons, Machaon and Podalirius, became famous physicians.
Nestor, you may remember, carried off the former, declaring, in the
oft-quoted phrase, that a doctor was better worth saving than many
warriors unskilled in the treatment of wounds.

s R. Pohl: De Graecorura medicis publicis, Berolini, Reimer, 1905; also Janus, Harlem, 1905,
X, 491-494.

8a J. Oehler: Janus, Harlem, 1909, XIV, 4; 111.

9 The Works of Aristotle, Oxford, Clarendon Press, Vol. IV, 1910, Bk. Ill, Chaps. II-IV,
pp. 511b-S16b.

FIG. 13.
Asklepios.

NATIONAL MUSEUM, ATHENS, FROM EPIDAUROS.

FIG. 14.

Asklepios with Staff, and Delphic Omphalos
in the right lower corner.

NATIONAL MUSEUM, NAPLES.

46 THE EVOLUTION OF MODERN MEDICINE

Later genealogies trace his origin to Apollo/" as whose son he is
usually regarded. "In the wake of northern tribes this god Aescula-
pius — a more majestic figure than the blameless leech of Homer's
song — came bj^ land to Epidaurus and was carried by sea to the east-

FIG. 1.5.
Asklepios and Hygieia (with the sacred snake).

VATICAN, ROME.

ward island of Cos. . . . Aesculapius grew in importance with the
growth of Greece, but may not have attained his greatest power until
Greece and Rome were one."^'

10 R. W. Chapman: Portrait of a Scholar, Oxford, 1920.

11 Louis Dyer: Studies of the Gods in Greece, 1891, p. 2-21.

FIG. 16.
Hygieia (daughter of Asklepios).

48 THE EVOLUTION OF MODERN MEDICINE

A word on the idea of the serpent as an emblem of the healing
art which goes far back into antiquity. The mj^stical character of
the snake, and the natural dread and awe inspired by it, early made
it a sj'mbol of supernatural power. There is a libation vase of Gudea,
c. 2350 B. C, found at Telloh, now in the Louvre (probably the
earliest representation of the symbol), with two serpents entwined

FIG. 17.
Coins representing Asklepios with snake.

ASKLEPIOS 49

round a staff ( Jastrow, PL 4) . From the earliest times the snake has
been associated with mystic and magic power, and even today, among
native races, it plays a part in the initiation of medicine men.

In Greece, the serpent became a symbol of Apollo, and prophetic
serpents were kept and fed at his shrine, as well as at that of his son,
Asklepios. There was an idea, too, that snakes had a knowledge of
herbs, which is referred to in the famous poem of Nikander on
Theriaka.^^ You may remember that when Alexander, the famous
quack and oracle monger, depicted by Lucian, started out "for reve-
nue," the first thing he did was to provide himself with two of the
large, harmless, yellow snakes of Asia Minor.

The exact date of the introduction of the cult into Greece is not
known, but its great centres were at Epidaurus, Cos, Pergamos and
Tricca. It throve with wonderful rapidity. Asklepios became one
of the most popular of the gods. By the time of Alexander it is
estimated that there were between three and four hundred temples
dedicated to him.

His worship was introduced into Rome at the time of the Great
Plague at the beginning of the third century B. C. (as told by Livy
in Book XI), and the temple on the island of Tiber became a famous
resort. If you can transfer in imagination the Hot Springs of Vir-
ginia to the neighborhood of Washington, and put there a group of
buildings such as are represented in these outlines of Caton's^^ (p. 52) ,
add a sumptuous theatre with seating capacity for 20,000, a stadium
600 feet long with a seating capacity of 12,000, and all possible acces-
sories of art and science, you will have an idea of what the temple
at Epidaurus, a few miles from Athens, was. "The cult flourished
mostly in places which, through climatic or hygienic advantages, were
natural health resorts. Those favoured spots on hill or mountain,
in the shelter of forests, by rivers or springs of pure flowing water,
were condvicive to health. The vivifying air, the well cultivated
gardens surrounding the shrine, the magnificent view, all tended to
cheer the heart with new hope of cure. Many of these temples owed
their fame to mineral or merely hot springs. To the homely altars,
erected originally by sacred fountains in the neighbourhood of health-

12 Lines 31, etc., and Scholia; cf. W. R. Halliday: Greek Divination, London, 1913, p. 88.

13 Caton: Temples and Ritual of Asklepios, 2d ed., London, 1900.

50 THE EVOLUTION OF MODERN MEDICINE

FIG. 18.

vEsculapian serpent, carved in travertine on the Isola San Bartolommeo
in the Tiber, near Rome.

giving mineral springs, were later added magnificent temples, pleas-
ure-grounds for festivals, gymnasia in which bodily ailments were
treated by physical exercises, baths and inunctions, also, as is proved
bjr excavations, living rooms for the patients. Access to the shrine
was forbidden to the unclean and the impure, pregnant women and
the mortally afflicted were kept away; no dead bodj^ could find a
resting-jilace within the holj^ precincts, the shelter and the cure of
the sick being undertaken by the keepers of inns and boarding-houses
in the neighbourhood. The suppliants for aid had to submit to care-
ful purification, to bathe in sea, river or spring, to fast for a pre-
scribed time, to abjure wine and certain articles of diet, and they
were only permitted to enter the temple when they were adequately
prepared by cleansing, inunction and fumigation. This lengthy and
exhausting preparation, partly dietetic, partly suggestive, was accom-

o

OS

52 THE EVOLUTION OF MODERN MEDICINE

panied by a solemn service of prayer and sacrifice, whose symbolism
tended highly to excite the imagination.""

The temples were in charge of members of the guild or fraternity,
the head of which was often, though not necessarily, a physician.

Outline Restoration

of Some of the Principal Buildings

of the Hieron of Epidauros

-HZ

( Stmt iwmJtIiaii a tku flat tart lni»
^ henvaid fnB lii imftrtal aert fmilhUd lij

M, C»v»*DiAj Jtras tki friutl jitr.)

ir -nri Hduk or Ernunoi (R.C.)

B OfTMM^m IT). C Tnnr'' •* AiU^"'

PLATE I— Ow

I Soulli Prarrlin, DT pcubLr Ttapic .

D D EMI ud -dl AbUfD ! til* lo"« ilorj o/ (he liIUI u4 lln ilrri \c%t
10 d tn thowB. E Tbt Thoto.. F Ttmplr tJ Arltai*. C The Cr»«. H Si
I Lb(i i)ur (f), J South boonJu) o* ■MHO (rttiBO, ipf./nillj o* Ulr cddiObciioil
K The 'S^Din bgildisf.* L Tbt tutln nr Ajklfm md protubk iHl I* libiir).
M C)Fmauiiin at bilhi or hinul. N Tbc baillLOi villi (av ^t^iufln, prahi^l; i
hmliU O Rinnu liiiJdiii| P Rddui bmds. Q Snppexd |>wi!u •< KMjn. R Narth-
taWD celnaUi. S Mwib^.lltm q-utru^k, > li«UI C}, T Tunpta •< AphrodM.
U Northm Pti^^ls, OD raid riom town of Ei>«l><il». V Rums bvldst. W t4iiilbm
IxModu, dI piKtsii (P). X Sudxim. T C«l, or |icrhip

lubtnrufiD puu^r, comniviicaliaf fe'ilii prceuiel [^. « Tunflr of AiUeptfo tod EfTpIitA
ApollO) bUfdifli Id Cinjdiu ^ Sapj^pHrF icm^lf of lb« bouDlifoI pJi. > Tcmptf oj
Thiniu (0. i ReUToa or bilh. > PoiRi«i ol mcient omcurr.

The |ruL ihutTE ■■

NOTE.THIS BIIJLDIKciN)*
ISSfTUKTEDISOVlllOS
MORE■nJTHEE^STTHM^
IS HERE REPRESENTED,

FIG. 20,

Hieron at Epidaurus.

yCaton?}

The Chief was appointed annually. From Caton's excellent sketch''
you can get a good idea of the ritual, but still better is the delightful
description given in the "Plutus" of Aristophanes. After offering
honey-cakes and baked meats on the altar, the suppliants arranged
themselves on the pallets.

14 Max Neuburger: History of Medicine, English translation, Oxford, 1910, p. 94.

15 Caton: Temples and Ritual of Asklepios, 2d ed., London, 1900. '

ASKLEPIOS 53

Soon the Temple servitor
Put out the lights and bade us fall asleep,
Nor stir, nor speak, whatever noise we heard.
So down we lay in orderly repose.
And I could catch no slumber, not one wink.
Struck by a nice tureen of broth which stood
A little distance from an old wife's head.
Whereto I marvellously longed to creep.
Then, glancing upwards, T beheld the priest
Whipping the cheese-cakes and figs from off
The holy table ; thence he coasted round
To every altar spying what was left.
And everything he found he consecrated
Into a sort of sack — ^^

a procedure which reminds one of the story of "Bel and the Dragon."
Then the god came, in the person of the priest, and scanned each
patient. He did not neglect physical measures, as he brayed in a
mortar cloves, Tenian garlic, verjuice, squills and Sphettian vinegar,
with which he made application to the eyes of the patient.

Then the God clucked.
And out there issued from the holy shrine
Two great, enormous serpents. . . .
And underneath the scarlet cloth they crept,
And licked his eyelids, as it seemed to me ;
And, mistress dear, before you could have drunk
Of wine ten goblets, Wealth arose and saw.^^

The incubation sleep, in which indications of cure were divinely sent,
formed an important part of the ritual.

The Asklepieion, or Health Temple of Cos, recently excavated,
is of special interest, as being very probably the scene of the labors
of Hippocrates, who was always stated to be an Asklepiad. It is
known that Cos was a great medical school. The investigations of
Professor Rudolf Hertzog have shown that it was very nearly the
counterpart of the temple at Epidaurus.

^sculapian temples must have furnished a rich field for clinical

16 Aristophanes : B. B. Roger's translation, London, Bell & Sons, 190T, Vol. VI, 11. 668, etc;,
733 ff.
f! Ibid.

54 THE EVOLUTION OF MODERN MEDICINE

FIG. 21.

Temple-rite at Epidaurus.
{Caton.)

research, like our modern hospitals,
and the larger one had rich libraries,
full of valuable manuscripts and rec-
ords of cases. That there should have
been secular Asklepiads connected
with the temple, who were freed en-
tirely from its superstitious practices
and theurgic rites, is very extraor-
dinary ; yet perhaps not so much so as
one might think. How often have we
physicians to bow ourselves in the
house of Rimmon! It is very much
the same today at Lourdes, where liay
physicians have to look after scores
of patients whose faith is too weak
or whose maladies are too strong to
be relieved by Our Lady of this fa-
mous shrine. Even in the Christian
era, there is evidence of the association of distinguished physicians
with ^sCulapian temples. I notice that in one of his anatomical
treatises, Galen speaks with affection of a citizen of Pergamos who
has been a great benefactor of the ^sculapian temple of that city. In
"Marius, the Epicurean," Pater gives a delightful sketch of one of
those temple health resorts, and brings in Galen, stating that he had
himself undergone the temple sleep ; but to this I can find no reference
in the general index of Galen's works.

From the votive tablets found at Epidaurus, we get a very good
idea of the nature of the cases and of the cures. A large number of
them have now been deciphered. There are evidences of various
forms of diseases of the joints, aflPections of women, wounds, baldness,
gout; but we are again in the world of miracles, as you may judge
from the following: "Heraicus of Mytilene is bald and entreats the
God to make his hair grow. An ointment is applied over night and
the next morning he has a thick crop of hair."

There are indications that operations were performed and abscesses
opened. From one we gather that dropsy was treated in a novel
way: Asklepios cuts off the patient's head, holds him up by the
heels, lets the water run out, claps on the patient's head again. Here
is one of the invocations :

FIG. i-i.
Asklepieion at Cos.

FIG. 2.S.
Plan of the Asklepieion at Cos (from excavations of 1902-1904).

CM ^

O

6 =r

ASKLEPIOS

57

03: ZudnhU^fU^oH

FIG. ^25.

Ex-voto of a case of disease
of the eve.

FIG. 26.

Modern German ex-voto of
disease of the eyes.

"Oh, blessed Asklepios, God of Healing, it is thanks to thj"- skill
that Diophantes hopes to be relieA-ed from his incurable and horrible
gout, no longer to move like a crab, no longer to walk upon thorns,
but to have sound feet as thou hast decreed."

The priests did not neglect the natural means of healing. The
inscriptions show that great attention was jiaid to diet, exercise,
massage and bathing, and that when necessarj', drugs were used.
Birth and death were believed to defile the sacred precincts, and it
was not until the time of the Antonines that provision was made at
Epidaurus for these contingencies.

One practice of the temple was of special interest, vh., the incu-
bation sleep, in which dreams were suggested to the patients. In the
religion of Babylonia, an important part was played by the mystery
of sleep, and the interjiretation of dreams; and no doubt from the
East the Greeks took over the practice of divination in sleep, for in
the iEsculapian cult also, the incubation sleep played a most imj)or-
tant role. That it continued in later times is well indicated in the
orations of Aristides, the arch-neurasthenic of ancient history, who
was a great dreamer of dreams. The oracle of Amphiaraus in Attica
sent dreams into the hearts of his consultants. "The priests take the
inquirer, and keep him fasting from food for one day, and from wine
for three daj^s, to give him perfect spiritual lucidity to absorb the di-
vine communication" (Phillimore's "Apollonius of Tyana," Bk. II,

58 THE EVOLUTION OF MODERN MEDICINE

Ch. XXXVII) . How incubation sleep was carried into the Christian
Church, its association with St. Cosmas and St. Damian and other
saints, its practice throughout the Middle Ages, and its continuation
to our own time may be read in the careful study of the subject made
by Miss Hamilton (now Mrs. Dickens) .^* There are still in parts of
Greece and in Asia Minor shrines at which incubation is practised
regularly, and if one may judge from the reports, with as great suc-
cess as in Epidaurus. At one place in Britain, Christchurch in Mon-
mouthshire, incubation was carried on till the early part of the nine-
teenth century. Now the profession has come back to the study of
dreams," and there are prof essors as ready to give suggestive interpre-
tations to them, as in the days of Aristides. As usual, Aristotle seems
to have said the last word on the subject: "Even scientific physicians
tell us that one should pay diligent attention to dreams, and to hold
this view is reasonable also for those who are not practitioners but
speculative philosophers,"^" but it is asking too much to think that the
Deity would trouble to_send dreams to very simple people and to
animals, if they were designed in any way to reveal the future.

In its struggle with Christianity, Paganism made its last stand in
the temples of Asklepios. The miraculous healing of the saints super-
seded the cures of the heathen god, and it was wise to adopt the useful
practice of his temple.

HIPPOCRATES AND THE HIPPOCRATIC WRITINGS

Deservedly the foundation of Greek Medicine is associated with the
name of Hippocrates, a native of the island of Cos; and yet he is a
shadowy personality, about whom we have little accurate first-hand
information. This is in strong contrast to some of his distinguished
contemporaries and successors, for example, Plato and Aristotle,
about whom we have such full and accurate knowledge. You will,
perhaps, be surprised to hear that the only contemporary mention
of Hippocrates is made by Plato. In the "Protagoras," the young
Hippocrates, son of Apollodorus has come to Protagoras, "that
mighty wise man," to learn the science and knowledge of human life.

IS Mary Hamilton: Incubation, or the Cure of Disease in Pagan Temples and Christian
Churches, London, 1906.

19 Freud: The Interpretation of Dreams, translation of third edition by A. A. Brill, 1913.

20 Aristotle: Parva Naturalia, De divinatione per somnium, Ch. I, Oxford ed., ~\^ol. Ill,
463 a.

J

FIG. 27.
Bust of Hippocrates.

BRITISH MUSEUM.

60 THE EVOLUTION OF MODERN MEDICINE

Socrates asked him: "If . . . you had thought of going to Hippoc-
rates of Cos, the Asclepiad, and were about to give him your money,
and some one had said to you, 'You are paying money to your name-
sake Hippocrates, O Hippocrates; tell me, what is he that you give
him money?' how would you have answered?" "I should say," he
replied, "that I gave money to him as a physician." "And what will
he make of you?" "A physician," he said. And in the Phsedrus, in
reply to a question of Socrates whether the nature of the soul could
be known intelligently without knowing the nature of the whole,
Phgedrus rephes: "Hippocrates, the Asclepiad, says that the nature,
even of the body, can only be understood as a whole." (Plato, I, 311 ;
III, 270— Jowett, I, 131, 479.)

Several lives of Hippocrates have been written. The one most
frequently quoted is that of Soranus (probably of Ephesus), a physi-
cian of the time of Trajan, and "the statements which he gives are
usually accepted, viz., that he was born in the island of Cos in the year
460 B. C. ; that he belonged to an Asklepiad family of distinction, that
he travelled extensively, visiting Thrace, Thessaly, and various other
parts of Greece; that he returned to Cos, where he became the most
renowned physician of his period, and died about 375 B. C. Aris-
totle mentions him but once, calling him "the great Hippocrates."
Busts of him are common; one of the earliest of which, and I am told
the best, dating from Roman daj^s and now in the British Museum, is
here represented.

Of the numerous writings attributed to Hippocrates it cannot easily
be determined which are really the work of the Father of Medicine
himself. They were collected at the time of the Alexandrian School,
and it became customary to write commentaries upon them; much of
the most important information we have about them, we derive from
Galen. The earliest manuscript is the "Codex Laurentianus" of
Florence, dating from the ninth century, a representation of which
(thanks to Commendatore Biagi) is annexed. Those of you who are
interested, and wish to have full references to the various works attrib-
uted to Hippocrates, will find them in "Die Handschriften der anti-
ken Aerzte" of the Prussian Academy, edited by Diels (Berlin, 1905) .
The Prussian Academy has undertaken the editorship of the "Corpus
Medicorum Grgecorum." There is no complete edition of them in
English. In 1849 the Deeside physician, Adams, published (for the

HIPPOCRATES

61

old Sydenham Society) a translation of the most important works, a
valuable edition and easily obtained. Littre's ten-volume edition
("(Euvres completes d'Hippocrate," Paris, 1839-1861) is the most

& ■*' i

■ <

a4*;

.^iffi' 1^"^

. ix^ In. yi Iri, cr ■ ^. j.

-or./

:^^«i'

•/^,

h'r<l

FIG. 28.

Earliest known Manuscript of Hippocrates.

(Ninth Centur.y.)

{Codex Lanrentianus , Florence.)

important for reference. Those of j^ou who want a brief but very
satisfactory^ account of the HijDpocratic writings, with numerous ex-
tracts, will find the volume of Theodor Beck (Jena, 1907) very useful.
I can only indicate, in a verj^ brief way, the special features of the

62 THE EVOLUTION OF MODERN MEDICINE

Hippocratic writings that have influenced the evolution of the science
and art of medicine.

The first is undoubtedly the note of humanity. In his introduction
to "The Rise of the Greek Epic,"^^ Gilbert Murray emphasizes the
idea of service to the community as more deeply rooted in the Greeks
than in us. The question they asked about each writer was, "Does he
help to make better men?" or "Does he make life a better thing?"
Their aim was to be useful, to be helpful, to make better men in the
cities, to correct life, "to make gentle the life of the world." In this
brief phrase were summed up the aspirations of the Athenians, like-
wise illuminated in that remarkable saying of Prodicus (fifth century
B. C.) , "That which benefits human life is God." The Greek view of
man was the very antithesis of that which St. Paul enforced upon the
Christian world. One idea pervades thought from Homer to Lucian
like an aroma — pride in the body as a whole. In the strong conviction
that "our soul in its rose mesh" is quite as much helped by flesh as
flesh by the soul the Greek sang his song — "For pleasant is this flesh."
Just so far as we appreciate the value of the fair mind in the fair body,
so far do we apprehend ideals expressed by the Greek in every depart-
ment of life. The beautiful soul harmonizing with the beautiful body
was as much the glorious ideal of Plato as it was the end of the educa-
tion of Aristotle. What a splendid picture in Book III of the
"Republic," of the day when "... our youth will dwell in a land of
health, amid fair sights and sounds and receive the good in everything ;
and beauty, the effluence of fair works, shall flow into the eye and ear
like a health-giving breeze from a purer region, and insensibly draw
the soul from earliest years into likeness and sympathy with the beauty
of reason." The glory of this zeal for the enrichment of this present
life was revealed to the Greeks as to no other people, but in respect
to care for the body of the common man, we have only seen its fulfll-
ment in our own day, as a direct result of the methods of research
initiated by them. Everywhere throughout the Hippocratic writings
we flnd this attitude towards life, which has never been better
expressed than in the fine phrase, "Where there is love of humanity
there will be love of the profession." This is well brought out in the
qualifications laid down by Hippocrates for the study of medicine.
"Whoever is to acquire a competent knowledge of medicine ought to

21 Oxford, Clarendon Press, 2d ed., 1911.

HIPPOCRATES 63

be possessed of the following advantages: a natural disposition; in-
struction; a favourable position for the study; early tuition; love of
labour; leisure. First of all, a natural talent is required, for when
nature opposes, everything else is vain ; but when nature leads the way
to what is most excellent, instruction in the art takes place, which the
student must try to appropriate to himself by reflection, becoming an
early pupil in a place well adapted for instruction. He must also
bring to the task a love of labour and perseverance, so that the instruc-
tion taking root may bring forth proper and abundant fruits." And
the directions given for the conduct of life and for the relation which
the physician should have with the public are those of our code of
ethics todaJ^ Consultations in doubtful cases are advised, touting
for fees is discouraged. "If two or more ways of medical treatment
were possible, the physician was recommended to choose the least im-
posing or sensational; it was an act of 'deceit' to dazzle the patient's
eye by brilliant exhibitions of skill which might A'^ery well be dispensed
with. The practice of holding public lectures in order to increase his
reputation was discouraged in the physician, and he was especially
warned against lectures tricked out with quotations from the poets.
Physicians who pretended to infallibility in detecting even the
minutest departure from their prescriptions were laughed at; and
finally, there were precise bye-laws to regulate the personal behaviour
of the physician. He was enjoined to observe the most scrupulous
cleanliness, and was advised to cultivate an elegance removed from all
signs of luxury, even down to the detail that he might use perfumes,
but not in an immoderate degree.'"' But the high-water mark of
professional morality is reached in the famous Hippocratic oath,
which Gomperz calls "a monument of the highest rank in the history
of civilization." It is of small matter whether this is of Hippocratic
date or not, or whether it has in it Egyptian or Indian elements : its
importance lies in the accuracy with which it represents the Greek
spirit. For twenty-five centuries it has been the "credo" of the pro-
fession, and in many universities it is still the formula with which men
are admitted to the doctorate.

I swear by Apollo the physician and JSsculapius and Health (Hygieia) and
All-Heal (Panacea) and all the gods and goddesses, that, according to my
ability and judgment, I will keep this oath and this stipulation — to reckon

22 Gomperz: Greek Thinkers, Vol. I, p. 381.

64 THE EVOLUTION OF MODERN MEDICINE

him who taught me this art equally dear to me as my parents, to share my
substance with him, and relieve his necessities if required ; to look upon his
offspring in the same footing as my own brothers, and to teach them this art,
if they shall wish to learn it, without fee or stipulation; and that by precept,
lecture, and every other mode of instruction, I will impart a knowledge of my
art to my own sons, and those of my teachers, and to disciples bound by a
stipulation and oath according to the law of medicine, but to none others. I
will follow that system of regimen which, according to my ability and judge-
ment, I consider for the benefit of my patients, and abstain from whatever is
deleterious and mischievous.

I will give no deadly medicine to anyone if asked, nor suggest any such
counsel; and in like manner I will not give to a woman a pessary to produce
abortion.

With purity and with holiness I will pass my life and practice my art.

I will not cut persons labouring under the stone, but will leave this to be
done by men who are practitioners of this work.

Into whatsoever houses I enter, I will go into them for the benefit of the sick,
and will abstain from every voluntary act of mischief and corruption, and,
further, from the abduction of females or males, of freemen and slaves. What-
ever, in connection with my professional practice, or not in connection with it,
I see or hear, in the life of men, which ought not to be spoken of abroad, I will
not divulge, as reckoning that all such should be kept secret.

While I continue to keep this Oath unviolated, may it be granted to me to
enjoy life and the practice of the art, respected by all men, in all times ! But
should I trespass and violate this Oath, may the reverse be my lot !

(Adams, II, 779, cf. Littre, IV, 628.)

In his ideal republic, Plato put the physician low enough, in the
last stratum, indeed, but he has never been more honorably placed
than in the picture of Athenian society given by this author in the
"Symposium." Here the physician is shown as a cultivated gentle-
man, mixing in the best, if not always the most sober, society.
Eryximachus, the son of Acumenus, himself a physician, plays in this
famous scene a typical Greek part"" — a strong advocate of temper-
ance in mind and body, deprecating, as a physician, excess in drink, he
urged that conversation should be the order of the day and he had the
honor of naming the subject — "Praise of the God of Love." Inci-
dentally Eryximachus gives his view of the nature of disease, and
shows how deeply he was influenced by the views of Empedocles:

22a Professor Gildersleeve's view of Eryximachus is less favorable (Johns Hopliins Univer-
sity Circular, Baltimore, January, 1887). Plato, III, 186 — Jowett, I, 556.

JtlXJrjfUL^-ttii-iJliO DO

". . .SO too in the body the good and healthy elements are to be
indulged, and the bad elements and the elements of disease are not to
be indulged, but discouraged. And this is what the physician has to
do, and in this the art of medicine consists: for medicine may be
regarded generally as the knowledge of the loves and desires of the
body and how to satisfy them or not ; and the best physician is he who
is able to separate fair love from foul, or to convert one into the other ;
and he who knows how to eradicate and how to implant love, whichever
is required, and can reconcile the most hostile elements in the constitu-
tion and make them loving friends, is a skilful practitioner."

The second great note in Greek medicine illustrates the directness
with which they went to the very heart of the matter. Out of mysti-
cism, superstition and religious ritual the Greek went directly to
nature and was the first to grasp the conception of medicine as an art
based on accurate observation, and an integral part of the science of
man. What could be more striking than the phrase in "The Law,"
"There are, in effect, two things, to know and to believe one knows;
to know is science ; to believe one knows is ignorance" ?"" But no single
phrase in the writings can compare for directness with the famous
aphorism which has gone into the literature of all lands: "Life is short
and Art is long; the Occasion fleeting, Experience fallacious, and
Judgment difficult."

Everywhere one finds a strong, clear common sense, which refuses
to be entangled either in theological or philosophical speculations.
What Socrates did for philosophy Hippocrates may be said to have
done for medicine. As Socrates devoted himself to ethics, and the
apphcation of right thinking to good conduct, so Hippocrates insisted
upon the practical nature of the art, and in placing its highest good in
the benefit of the patient. Empiricism, experience, the collection of
facts, the evidence of the senses, the avoidance of philosophical specu-
lations, were the distinguishing features of Hippocratic medicine.
One of the most striking contributions of Hippocrates is the recogni-
tion that diseases are only part of the processes of nature, that there
is nothing divine or sacred about them. With reference to epilepsy,
which was regarded as a sacred disease, he says, "It appears to me to
be no wise more divine nor more sacred than other diseases, but has a
natural cause from which it originates like other affections; men

23 Littre: CEuvres d'Hippocrate, Vol. IV, pp. 641-642.

66 THE EVOLUTION OF MODERN MEDICINE

regard its nature and cause as divine from ignorance." And in
another place he remarks that each disease has its own nature, and that
no one arises without a natural cause. He seems to have been the first
to grasp the conception of the great healing powers of nature. In his
long experience with the cures in the temples, he must have seen scores
of instances in which the god had worked the miracle through the vis
medicatrix naturcej and to the shrewd wisdom of his practical sugges-
tions in treatment may be attributed in large part the extraordinary-
vogue which the great Coan has enjoyed for twenty- five; centuries.
One may appreciate the veneratioii with which the Father of Medicine
was regarded by the attribute "divine" which was usually attached to
his name. Listen to this for directness and honesty of speech taken
from the work on the joints characterized by Littre as ''the great
surgical monument of antiquity" : "I have written this down deliber-
ately, believing it is valuable to learn of unsuccessful experiments, and
to know the causes of their non-success."

The note of freedom is not less remarkable throughout ,the Hippo-
cratic writings, and it is not easy to understand how a man brought up
and practising within the precincts of a famous ^sculapiari temple
could have divorced himself so wholly from the superstitions and
vagaries of the cult. There are probably grounds for Pliny's sugges-
tion that he benefited by the receipts written in the temple, registered
by the sick cured of any disease. "Afterwards," Pliny goes on to
remark in his characteristic way, "bee professed that course of
Physicke which is called Clinice Wherby physicians found such sweet-
nesse that afterwards there was no measure nor end of fees" ("Natural
History," XXIX, 1) . There is no reference in the Hippocratic writ-
ings to divination; incubation sleep is not often mentioned, nor are
charms, incantations or the practice of astrology. Here and there we
do find practices which jar upon modern feeling, but on the whole we
feel in reading the Hippocratic writings nearer to their spirit than to
that of the Arabians or of the many writers of the fifteenth and six-
teenth centuries A. D. And it was not only against the thaumaturgic
powers that the Hippocratic writings protested, but they express an
equally active reaction against the excesses and defects of the new
philosophy, a point brought out very clearly by Gomperz.^^ He
regards it as an undying glory of the school of Cos that after years

2iGomperz: Greek Thinkers, Vol. I, p. 296.

HIPPOCRATES 67

of vague, restless speculation it introduces steady sedentary habits
into the intellectual life of mankind. " 'Fiction to the right ! Reality
to the left !' was the battle-cry of this school in the war they were the
first to wage against the excesses and defects of the nature-philos-
ophy." Though the protest was effective in certain directions, we
shall see that the authors of the Hippocratic writings could not en-
tirely escape from the hypotheses of the older philosophers.

I can do no more than indicate in the briefest possible way some of
the more important views ascribed to Hippocrates. We cannot touch
upon the disputes between the Coan and Cnidian schools.^' You
must bear in mind that the Greeks at this time had no human anatomy.
Dissections were impossible; their physiologj'^ was of the crudest
character, strongly dominated by the philosophies. Empedocles
regarded the four elements, fire, air, earth and water, as "the roots of
all things," and this became the corner stone in the humoral pathology
of Hippocrates. As in the Macrocosm — the world at large — there
were four elements, fire, air, earth, and water, so in the Microcosm —
the world of man's body — there were four elements, or humors,
blood, phlegm, yellow bile (or choler) and black bile (or melancholy) ,
and they corresponded to the four qualities of matter, heat, cold,
dryness and moisture. For two thousand years, or more, these views
prevailed. In his "Regiment of Life" (1546) Thomas Phaer says:
"... which humours are called ye sones of the Elements because they
be complexioned like the foure Elements, for like as the Ayre is hot
and moyst: so is the blooud, bote and moyste. And as Fyer is bote
and dry : so is Cholere bote and dry. And as water is colde and moyst :
so is fleume colde and moyste. And as the Earth is colde and dry:
so Melancholy is colde and dry."'''

As the famous Regimen Sanitatis of Salernum, the popular family
hand-book of the Middle Ages, says :

Foure Humours raigne within our bodies wholly,
And these compared to foure elements. ^^

According to Littre, there is nowhere so strong a statement of these
views in the genuine works of Hippocrates, but they are found at

25 The student who wishes a fuller account is referred to the histories of (a) Neuburger,
Vol. 1, Oxford, 1910; (b) Withington, London, 1894.

26 Thomas Phaer: Regiment of Life, London, 1546.

27 The Englishman's Doctor, or the Schoole of Salerne, Sir John Harington's translation,
London, 1608, p. 2. Edited by B'rancis R. Packard, New York, 1930, p. 132. Harington's book
originally appeared dated: London 1607. (Hoe copy in the Henry E. Huntington Library.)

68 THE EVOLUTION OF MODERN MEDICINE

large in the Hippoeratic writings, and nothing can be clearer than the
following statement from the work "The Nature of Man": "The
body of man contains in itself blood and phlegm and yellow bile and
black bile, which things are in the natural constitution of his body, and
the cause of sickness and of health. He is healthy when they are in
proper proportion between one another as regards mixture and force
and quantity, and when they are well mingled together; he becomes
sick when one of these is diminished or increased in amount, or is
separated in the body from its proper mixture, and not properly
mingled with all the others." No words could more clearly express
the views of disease which, as I mentioned, prevailed until quite recent
years. The black bile, melancholy, has given us a great word in the
language, and that we have not yet escaped from the humoral pa-
thology of Hippocrates is witnessed by the common expression of
biliousness — "too much bile" — or "he has a touch of the liver." The
humors, imperfectly mingled, prove irritant in the body. They are
kept in due proportion by the innate heat which, by a sort of internal
coction gradually changes the humors to their proper proportion.
Whatever may be the primary cause of the change in the humors
manifesting itself in disease, the innate heat, or as Hippocrates terms
it, the nature of the body itself, tends to restore conditions to the norm ;
and this change occurring suddenly, or abruptly, he calls the "crisis,"
which is accomplished on some special day of the disease, and is often
accompanied by a critical discharge, or by a drop in the body tempera-
ture. The evil, or superabundant, humors were discharged and this
view of a special materies morhi, to be got rid of by a natural process
or a crisis, dominated pathology until quite recently. Hippocrates
had a great belief in the power of nature, the vis medicatrix naturce, to
restore the normal state. A keen observer and an active practitioner,
his views of disease, thus hastily sketched, dominated the profession
for twenty- five centuries ; indeed, echoes of his theories are still heard
in the schools, and his very words are daily on our lips. If asked what
was the great contribution to medicine of Hippocrates and his school
we could answer — the art of careful observation.

In the Hippoeratic writings is summed up the experience of Greece
to the Golden Age of Pericles. Out of philosophy, out of abstract
speculation, had come a way of looking at nature for which the physi-
cians were mainly responsible, and which has changed forever men's

ARISTOTLE 69

views on disease. Medicine broke its leading strings to religion and
philosophy — a tottering, though lusty, child whose fortunes we are to
follow in these lectures. I have a feeling that, could we know more of
the medical history of the older races of which I spoke in the first
lecture, we might find that this was not the first-born of Asklepios,
that there had been many premature births, many still-born offspring,
even live-births — the products of the fertilization of nature by the
human mind ; but the record is dark, and the infant was cast out like
Israel in the chapter of Isaiah. But the high-water mark of mental
achievement had not been reached by the great generation in which
Hippocrates had labored. Socrates had been dead sixteen years, and
Plato was a man of forty-five, when far away in the north in the
little town of Stagira, on the peninsula of Mount Athqs in Macedonia
was, in 384 B. C, born a "man of men," the one above all others to
whom the phrase of Milton may be applied. The child of an Askle-
piad, Nicomachus, physician to the father of Philip, there must have
been a rare conjunction of the planets at the birth of the great Stagi-
rite. In the first circle of the "Inferno," Virgil leads Dante into a
wonderful company, "star-seated" on the verdure (he says) — the
philosophic family looking with reverence on "the Master of those
who know" — il maestro di color che sanno.'^ And with justice has
Aristotle been so regarded for these twenty-three centuries. No man
has ever swayed such an intellectual empire — in logic, metaphysics,
rhetoric, psychology, ethics, poetry, politics and natural history, in all
a creator, and in all still a master. The history of the human mind
offers no parallel to his career. As the creator of the sciences of
comparative anatomy, systematic zoology, embryology, teratology,
botany and physiology, his writings have an eternal interest. They
present an extraordinary accumulation of facts relating to the struc-
ture and functions of various parts of the body. It is an unceasing
wonder how one man, even with a school of devoted students, could
have done so much.

Dissection — already practised by Alcmseon, Democritus, Diogenes
and others — was conducted on a large scale, but the adult human body
was still taboo. Aristotle confesses that the "inward parts of man are
known least of all," and he had never seen the human kidneys or

28 The "Good collector of qualities,'' Dioscorides, Hippocrates, Avicenna, Galen and Aver-
roes were the medical members of the group. Dante, Inferno, canto iv.

70 THE EVOLUTION OF MODERN MEDICINE

uterus. In his physiology, I can refer to but one point — the pivotal
question of the heart and blood vessels. To Aristotle the heart was
the central organ controlling the circulation, the seat of vitality, the
source of the blood, the place in which it received its final elaboration
and impregnation with animal heat. The blood was contained in the
heart and vessels as in a vase — hence the use of the term "vessel."
"From the heart the blood-vessels extend throughout the body as in
the anatomical diagrams which are represented on the walls, for the
parts lie round these because they are formed out of them."^" The
nutrillient oozes through the blood vessels and the passages in each of
the parts "like water in unbaked pottery." He did not recognize any
distinction between arteries and veins, calling both (^XeySe? (Littre) ;
the vena cava is the great vessel, and the aorta the smaller; but both
contain blood. He did not use the word "arteria" ( dpTTjpia) for either
of them. There was no movement from the heart to the vessels but the
blood was incessantly drawn upon by the substance of the body and
as unceasingly renewed by absorption of the products of digestion,
the mesenteric vessels taking up nutriment very much as the plants
take theirs by the roots from the soil. From the lungs was absorbed
the pneuma, or spiritus, which was conveyed to the heart by the
pulmonary vessels — one to the right, and one to the left side. These
vessels in the lungs, "through mutual contact" with the branches of the
trachea, took in the pneuma. A point of interest is that the windpipe,
or trachea, is called "arteria," both by Aristotle and by Hippocrates
("Anatomy," Littre, VIII, 539). It was the air-tube, disseminating
the breath through the lungs. We shall see in a few minutes how the
term came to be applied to the arteries, as we know them. The pulsa-
tion of the heart and arteries was regarded by Aristotle as a sort of
ebullition in which the liquids were inflated by the vital or innate heat,
the fires of which were cooled by the pneuma taken in by the lungs and
carried to the heart by the pulmonary vessels.

In Vol. IV of Gomperz' "Greek Thinkers," you will find an admi-
rable discussion on Aristotle as an investigator of nature, and those of
you who wish to study his natural history works more closely may do
so easily — in the new translation which is in process of publication by
the Clarendon Press, Oxford. At the end of the chapter "De Respi-
ratione" in the "Parva Naturaha" (Oxford edition, 1908), we have

29 De Generatione Animalium, Oxford translation, Bk. II, Chap. 6, Works V, 743 a.

ALEXANDRIAN SCHOOL 71

Aristotle's attitude towards medicine expressed in a way worthy of a
son of the profession :

"But health and disease also claim the attention of the scientist, and
not merely of the physician, in so far as an account of their causes is
concerned. The extent to which these two diflPer and investigate
diverse provinces must not escape us, since facts show that their
inquiries are, at least to a certain extent, conterminous. For physi-
cians of culture and refinement make some mention of natural science,
and claim to derive their principles from it, while the most accom-
plished investigators into nature generally push their studies so far
as to conclude with an account of medical principles." (Works, III,
480 b.)

Theophrastus, a student of Aristotle and his successor, created the
science of botany and made possible the pharmacologists of a few
centuries later. Some of you doubtless know him in another guise —
as the author of the golden booklet on "Characters," in which "the
most eminent botanist of antiquity observes the doings of men with
the keen and unerring vision of a natural historian" (Gomperz) . In
the Hippocratic writings, there are mentioned 236 plants; in the
botany of Theophrastus, 4.55. To one trait of master and pupil I
must refer — the human feeling, not alone of man for man, but a
sympathy that even claims kinship with the animal world. "The spirit
with which he (Theophrastus) regarded the animal world found no
second expression till the present age" (Gomperz). Halliday, how-
ever, makes the statement that Porphyry^" goes as far as any modern
hiimanitarian in preaching our duty towards animals.

ALEXANDRIAN SCHOOL

From the death of Hippocrates about the year 375 B. C. till the
founding of the Alexandrian School, the physicians were engrossed
largely in speculative views, and not much real progress was made,
except in the matter of elaborating the humoral pathology. Only
three or four men of the first rank stand out in this period : Diodes the
Carystian, "both in time and reputation next and second to Hippoc-
rates" (Pliny), a keen anatomist and an encyclopeedic writer; but
only scanty fragments of his work remain. In some ways the most
important member of this group was Praxagoras, a native of Cos,

sow. R. Halliday: Greek Divination, London, Macmillan & Co., 1913.

72 THE EVOLUTION OF MODERN MEDICINE

about 340 B. C. Aristotle, you remember, made no essential distinc-
tion between arteries and veins, both of which he held to contain blood :
Praxagoras recognized that the pulsation was only in the arteries, and
maintained that only the veins contained blood, and the arteries air.
As a rule the arteries are empty after death, and Praxagoras believed
that they were filled with an aeriform fluid, a sort of pneuma, which
was responsible for their pulsation. The word arteria, which had
already been applied to the trachea, as an air-containing tube, was
then attached to the arteries ; on account of the rough and uneven char-
acter of its resonance the trachea was then called the arteria tracheia,
or the rough air-tube. We call it simply the trachea, but in French
the word trachee-artere is still used.

Praxagoras was one of the first to make an exhaustive study of the
pulse, and he must have been a man of considerable clinical acumen,
as well as boldness, to recommend in obstruction of the bowels the
opening of the abdomen, removal of the obstructed portion and
uniting the ends of the intestine by sutures.

After the death of Alexander, Egypt fell into the hands of his
famous general, Ptolemy, under whose care the city became one of the
most important on the Mediterranean. He founded and maintained a
museum, an establishment that corresponded very much to a modern
university, for the study of literature, science and the arts. Under
his successors, particularly the third Ptolemj?^, the museum developed,
more especially the library, which contained more than half a million
volumes. The teachers were drawn from all centres, and the names of
the great Alexandrians are among the most famous in the history of
human knowledge, including such men as Archimedes, Euclid, Strabo
and Ptolemy. } \

In mechanics and physics, astronomy, mathematics and optics, the
work of the Alexandrians constitutes the basis of a large part of our
modern knowledge. The school-boy of today — or at any rate of my
day — studies the identical problems that were set by Euclid 300 B. C,
and the student of physics still turns to Archimedes and Heron, and
the astronomer to Eratosthenes and Hipparchus. To those of you
who wish to get a brief review of the state of science in the Alexan-
drian School I would recommend the chapter in Vol. I of Danne-
mann's history.''

31 Friedrich Dannemann: Grundriss einer Geschichte der Naturwissenschaften, Vol. I, 3d
ed., Leipzig, 1908.

ALEXANDRIAN SCHOOL 73

Of special interest to us in Alexandria is the growth of the first
great medical school of antiquity. Could we have visited the famous
museum about 300 B. C, we should have found a medical school in
full operation, with extensive laboratories, libraries and clinics. Here
for the first time the study of the structure of the human body reached
its full development, till then barred everywhere by religious preju-
dice; but full permission was given by the Ptolemies to perform
human dissection and, if we may credit some authors, even vivi-
section. The original writings of the chief men of this school have not
been preserved, but there is a possibilitj^ that any day a papyrus may
be found which will supplement the scrappy and imperfect knowledge
afforded us by Pliny, Celsus and Galen. The two most distinguished
names are Herophilus — who, Pliny says, has the honor of being the
first physician "who searched into the causes of disease" — and
Erasistratus.

Herophilus, ille anatomicorum coryphceus, as Vesalius calls him, was
a pupil of Praxagoras, and his name is still in everyday use by medical
students, attached to the torcular Herophili. Modern anatomy prac-
tically dates from these Alexandrines, who described the valves of the
heart, the duodenum, and many of the important parts of the brain;
they recognized the true significance of the nerves (which before their
day had been confounded with the tendons ) , distinguished between
motor and sensory nerVes, and regarded the brain as the seat of the
perceptive faculties and voluntary action. Herophilus counted the
pulse, using the water-clock for the purpose, and made manjr subtle
analyses of its rate and rhythm ; and, influenced by the musical theories
of the period, he built up a rhythmical pulse lore which continued in
medicine until recent times. He was a skilful practitioner and to him
is ascribed the statement that drugs are the hands of the gods. There
is a very modern flavor to his oft-quoted expression that the best
physician was the man who was able to distinguish between the
possible and the impossible.

Erasistratus elaborated the view of the pneuma, one form of which
he believed came from the inspired air, and passed to the left side of
the heart and to the arteries of the body. It was the cause of the
heart-beat and the source of the innate heat of the body, and it main-
tained the processes of digestion and nutrition. This was the vital
spirit; the animal spirit was elaborated in the brain, chieflj'- in the

74 THE EVOLUTION OF MODERN MEDICINE

ventricles, and sent by the nerves to all parts of the body, endowing the
individual with life and perception and motion. In this way a great
division was made between the two functions of the body, and two sets
of organs : in the vascular system, the heart and arteries and abdomi-
nal organs, life was controlled by the vital spirits ; on the other hand,
in the nervoijs system were elaborated the animal spirits, controlling
motion, sensation and the various special senses. These views on the
vital and animal spirits held unquestioned sway until well into the
eighteenth century, and we still, in a measure, express the views of the
great Alexandrian when we speak of "high" or "low" spirits.

GALEN

Pergamos has become little more than a name associated in our
memory with the fulminations of St. John against the seven churches
of Asia; and on hearing the chapter read, we wondered what was
"Satan's seat" and who were the "Nicolaitanes" whose doctrine he so
hated. Renewed interest has been aroused in the story of its growth
and of its intellectual rivalry with Alexandria since the wonderful
discoveries by German archaeologists which have enabled us actually
to see this great Ionian capital, and even the "seat of Satan." The
illustration here shown (Fig. 29) is of the famous city, in which you
can see the Temple of Athena Polls on the rock, and the amphi-
theatre. Its interest for us is connected with the greatest name, after
Hippocrates, in Greek medicine, that of Galen, born at Pergamos
A. D. 130, in whom was united as never before — and indeed one may
say, never since — the treble combination of observer, experimenter
and philosopher. His father, Nikon, a prosperous architect, was
urged in a dream to devote his son to the profession of medicine, upon
which study the lad entered in his seventeenth year under Satyrus.
In his writings, Galen gives many details of his life, mentioning the
names of his teachers, and many incidents in his Wander jahre, during
which he studied at the best medical schools, including Alexandria.
Returning to his native city he was put in charge of the gladiators,
whose wounds he said he treated with wine. In the year 162, he paid
his first visit to Rome, the scene of his greatest labors. Here he gave
public lectures on anatomy, and, became "the fashion." He mentions
many of his successes ; one of them is the well-worn story told also of

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76 THE EVOLUTION OF MODERN MEDICINE

FIG. 80.
Relief Map of Pergamos.

Erasistratus and Stratonice, but Galen's story is worth telling, and it
is figured as a miniature in the manuscripts of his works. (Fig.
31.) Called to see a lady he found her suffering from general malaise
without any fever or increased action of the pulse. He saw at once
that her trouble was mental and, like a wise physician, engaged her in
general conversation. Quite possibly he knew her story, for the name
of a certain actor, Pylades, was mentioned, and he noticed that her
pulse at once increased in rapidity and became irregular. On the next

GALEN

77

day he arranged that the name of another actor, Morphus, should be
mentioned, and on the third day the experiment was repeated but
without effect. Then on the fourth evening it was again mentioned
that Pylades was dancing, and the pulse quickened and became irreg-
ular, so he concluded that she was in love with Pylades. He tells

~1

FIG. 31.
Galen and Ladv Patient.

how he was first called to treat the Emperor JNIarcus Aurelius, who
had a stomach-ache after eating too much cheese. He treated the case
so successfully that the Emperor remarked, "I have but one physician,
and he is a gentleman." He seems to have had good fees, as he
received 400 aurei (about $2000) for a fortnight's attendance upon
the wife of Boethus.

He left Rome for a time in 168 A. D. and returned to Pergamos,
but was recalled to Rome by the Emperor, whom he accompanied on

78 THE EVOLUTION OF MODERN MEDICINE

an expedition to Germany. There are records in his writings of many
journeys, and busy with his practice in dissections and experiments
he passed a long and energetic life, dying, according to most authori-
ties, in the year 200 A. D.

A sketch of the state of medicine in Rome is given by Celsus in the
first of his eight books, and he mentions the names of many of the
leading practitioners, particularly Asclepiades, the Bithynian, a man
of great ability, and a follower of the Alexandrians, who regarded all
disease as due to a disturbed movement of the atoms. Diet, exercise,
massage and bathing were his great remedies, and his motto — tuto,
cito et jucunde — has been the emulation of all physicians. How
important a role he and his successors played until the time of Galen
may be gathered from the learned lectures of Sir Clifford Allbutt^^
on "Greek Medicine in Rome" and from Meyer- Steineg's "Theodorus
Priscianus und die romische Medizin."^' From certain lay writers we
learn that it was the custom for popular physicians to be followed on
their rounds by crowds of students. Martial's epigram (V, ix) is
often referred to :

Languebam : sed tu comitatus protinus ad me

Venisti centum, Symmache, discipulis.
Centum me tegigere manus Aquilone gelatas

Non habui febrem, Symmache, nunc habeo.

And in the "Apollonius of Tyana" by Philostratus, when Apollo-
nius wishes to prove an alibi, he calls to witness the physicians of his
sick friend, Seleucus and Straloctes, who were accompanied by their
clinical class to the number of about thirty students." But for a first-
hand sketch of the condition of the profession we must go to Pliny,
whose account in the twenty-ninth book of the "Natural History" is
one of the most interesting and amusing chapters in that delightful
work. He quotes Cato's tirade against Greek physicians, — corrupters
of the race, whom he would have banished from the citj^ — then he
sketches the career of some of the more famous of the physicians under
the Empire, some of whom must have had incomes never approached
at any other period in the history of medicine. The chapter gives a

32 Allbutt: British Medical Journal, London, 1909, ii, 1449; 1515; 1598.

33 Fischer, Jena, 1909.
Si Bk. VIII, Chap. VII.

GALEN 79

good picture of the stage on which Galen (practically a contemporary
of Pliny) was to plaj'^ so important a role. Pliny seems himself to
have been rather disgusted with the devious paths of the doctors of his
day, and there is no one who has touched with stronger language upon
the weak points of the art of physic. In one place he says that it
alone has this peculiar art and privilege, "That whosoever professeth
himself a physician, is straightwaies beleeved, say what he will: and
yet to speake a truth, there are no lies dearer sold or more daungerous
than those which proceed out of a Physician's mouth. Howbeit, we
never once regard or look to that, so blind we are in our deepe per-
suasion of them, and feed our selves each one in a sweet hope and
plausible conceit of our health by them. Moreover, this mischief there
is besides. That there is no law or statute to punish the ignorance of
blind Physicians, though a man lost his life by them: neither was
there ever any man knowne, who had revenge of recompence for the
evill intreating or misusage under their hands. They learne their skill
by endaungering our lives: and to make proof e and experiments of
their medicines, they care not to kill us.'"'' He says it is hard that,
while the judges are carefully chosen and selected, physicians are prac-
tically their own judges, and that of the men who may give us a quick
despatch and send us to Heaven or Hell, no enquiry or examination
is made of their quality and worthiness. It is interesting to read so
early a bitter criticism of the famous "Theriaca," a great compound
medicine invented by Antiochus III, which had a vogue for fifteen
hundred years.

But we must return to Galen and his works, which comprise the
most voluminous body of writings left by any of the ancients. The
great edition is that in twenty volumes by Kiihn (1821-1833). The
most useful editions are the "Juntines" of Venice, which were issued
in thirteen editions, and in connection with the fourth a very useful
index was published by Brassavola. A critical study of the writings
is at present being made by German scholars for the Prussian
Academy, which will issue a definitive edition of his works.

Galen had an eclectic mind and could not identify himself with any
of the prevailing schools, but regarded himself as a disciple of Hip-
pocrates. For our purpose, both his philosophy and his practice are of

35 Pliny: Natural History (XXIX, 1), Philemon HoUand's version, London, 1601, II, 347.

80 THE EVOLUTION OF MODERN MEDICINE

minor interest in comparison with his great labors in Anatomy and
physiology.

In anatomy, he was a pupil of the Alexandrians to whom he con-
stantly refers. Times must have changed since the days of He-
rophilus, as Galen does not seem ever to have had an opportunity
of dissecting the human body, and he laments the prejudice which
prevents it. In the study of osteology, he urges the student to be on
the lookout for an occasional human bone exposed in a graveyard,
and on one occasion he tells of finding the carcass of a robber with
the bones picked bare by birds and beasts. Failing this source, he
advises the student to go to Alexandria, where there were still two
skeletons. He himself dissected chiefly apes and pigs. His osteologj'^
was admirable, and his little tractate "De Ossibus" could, with very
few changes, be used today by a hygiene class as a manual. His
description of the muscles and of the organs is very full, covering,
of course, many sins of omission and of commission, but it was the
culmination of the study of the subject by Greek physicians.

His work as a physiologist was even more important, for, so far as
we know, he was the first to carry out experiments on a large scale.
In the first place, he was within an ace of discovering the circulation of
the blood. You may remember that through the errors of Praxagoras
and Erasistratus, the arteries were believed to contain air and got their
name on that account: Galen showed by experiment that the arteries
contain blood and not air. He studied particularly the movements of
the heart, the action of the valves, and the pulsatile forces in the
arteries. Of the two kinds of blood, the one, contained in the venous
system, was dark and thick and rich in grosser elements, and served for
the general nutrition of the body. This system took its oi'igin, as is
well shown in the figure, in the liver, the central organ of nutrition and
of sanguification. From the portal system were absorbed, through the
stomach and intestines, the products of digestion. From the liver
extend the venae cavae, one to supply the head and arms, the other the
lower extremities : extending from the right heart was a branch, corre-
sjjonding to the pulmonary artery, the arterial vein which distributed
blood to the lungs. This was the closed venous system. The arterial
system, shown, as you see, quite separate in Figure 31a, was full of a
thinner, brighter, warmer blood, characterized by the presence of an
abundance of the vital spirits. Warmed in the ventricle, it distributed

FIG. 31a.

Schema illustrating the Galenic doctrine of the circulation.

{From Harvey: La circulation du sang. Traduction Jrangaise
par Charles Richet, Paris, 1879, p. 17.)

a = aorta. b = anastomosis of arteries and veins. C = liver.
D = stomach, f = distributory veins passing from liver, g = vena
cava. h = pores in interventricular septum. i = left auricle.
1 =: left ventricle, m = pulmonary vein. N = lungs, o = pulmo-
nary artery. P = right ventricle.

82 THE EVOLUTION OF MODERN MEDICINE

vital heat to all parts of the body. The two systems were closed and
communicated with each other only through certain pores or perfora-
tions in the septum separating the ventricles. At the periphery, how-
ever, Galen recognized (as had been done already by the Alexan-
drians) that the arteries anastomose with the veins, ". . . and they
mutually receive from each other blood and spirits through certain
invisible and extremely small vessels."

It is difficult to understand how Galen missed the circulation of the
blood. He knew that the valves of the heart determined the direction
of the blood that entered and left the organ, but he did not appreciate
that it was a pump for distributing the blood, regarding it rather as a
fireplace from which the innate heat of the body was derived. He
knew that the pulsatile force was resident in the walls of the heart and
in the arteries, and he knew that the expansion, or diastole, drew blood
into its cavities, and that the systole forced blood out. Apparently his
view was that there was a sort of ebb and flow in both systems — and
yet, he uses language just such as we would, speaking of the venous
system as ". . .a conduit full of blood with a multitude of canals
large and small running out from it and distributing blood to all parts
of the body." He compares the mode of nutrition to irrigating canals
and gardens, with a wonderful dispensation by nature that they should
"neither lack a sufficient quantity of blood for absorption nor be
overloaded at any time with excessive supply." The function of
respiration was the introduction of the pneuma, the spirits which
passed from the lungs to the heart through the pulmonary vessels.
Galen went a good deal beyond the idea of Aristotle, reaching our
modern conception that the function is to maintain the animal heat,
and that the smoky matters derived from combustion of the blood
are discharged by expiration.

I have dwelt on these points in Galen's physiology, as they are
fundamental in the history of the circulation; and they are sufficient
to illustrate his position. Among his other brilliant experiments were
the demonstration of the function of the laryngeal nerves, of the
motor and sensory functions of the spinal nerve roots, of the effect of
transverse incision of the spinal cord, and of the effect of hemisection. \
Altogether there is no ancient physician in whose writings are con-
tained so many indications of modern methods of research.

GALEN 83

■^^^Galen's views of disease in general are those of Hippocrates, but
he introduces many refinements and subdivisions according to the
predominance of the four humors, the harmonious combination of
which means health, or eucrasia, while their perversion or improper
combination leads to dyscrasia, or ill health. In treatment he had not
the simplicity of Hippocrates: he had great faith in drugs and col-
lected plants from all parts of the known worldAfor the sale of which
he is said to have had a shop in the neighborhood of the Forum. As
I mentioned, he was an eclectic, heM^'hlmself aloof from the various
schools of the day, calling no ma^^piaster save Hippocrates. He
might be called a rational empiricist. \ He made war on the theoretical
practitioners of the day, particularly the Methodists, who, like some of
their modern followers, held that their businesswas with the disease
and not with the conditions out of which it arose^

No other physician has ever occupied the commanding position of
Clarissimus Galen. For fifteen centuries he dominated medical
thought as powerfully as did Aristotle in the schools. Not until the
Renaissance did daring spirits begin to question the infallibility of this
medical pope. But here we must part with the last and, in many ways,
the greatest of the Greeks — a man very much of our own type, who,
could he visit this country today, might teach us many lessons. He
would smile in scorn at the water supply of many of our cities, think-
ing of the magnificent aqueducts of Rome and of many of the colonial
towns — some still in use — which in lightness of structure and in dura-
bility testify to the astonishing skill of their engineers. There are
country districts in which he would find imperfect drainage and could
tell of the wonderful system by which Rome was kept sweet and clean.
Nothing would delight him more than a visit to Panama to see what
the organization of knowledge has been able to accomplish. Every-
where he could tour the country as a sanitary expert, preaching the
gospel of good water supply and good drainage, two of the great
elements in civilization, in which in many places we have not yet
reached the Roman standard.

CHAPTER III
MEDIEVAL MEDICINE

THERE are waste places of the earth which fill one with terror
— not simply because they are waste ; one has not such feelings
in the desert nor in the vast solitude of the ocean. Very differ-
ent is it where the desolation has overtaken a brilliant and flourishing
product of man's head and hand. To know that

. . . the liion and the Lizard keep
The Courts where Jamshyd gloried and drank deep

sends a chill to the heart, and one trembles with a sense of human
instability. With this feeling we enter the Middle Ages. Following
the glory that was Greece and the grandeur that was Rome, a desola-
tion came upon the civilized world, in which the light of learning
burned low, flickering almost to extinction. How came it possible
that the gifts of Athens and of Alexandria were deliberately thrown
away? For three causes. The barbarians shattered the Roman
Empire to its foundations. When Alaric entered Rome in 410 A. D.,
ghastly was the impression made on the contemporaries ; the Roman
world shuddered in a titanic spasm (Lindner). The land was a
garden of Eden before them, behind a howling wilderness, as is so
graphically told in Gibbon's great history. Many of the most im-
portant centres of learning were destroyed, and for centuries Minerva
and Apollo forsook the haunts of men. The other equally important
cause was the change wrought by Christianity. The brotherhood of
man, the care of the body, the gospel of practical virtues formed the
essence of the teaching of the Founder — in these the Kingdom of
Heaven was to be sought ; in these lay salvation. But the world was
very evil, all thought that the times were waxing late, and into men's
minds entered as never before a conviction of the importance of the

MEDIEVAL MEDICINE 85

four last things — death, judgment, heaven and hell. One obstacle
alone stood between man and his redemption, the vile body, "this
muddy vesture of decay," that so grossly wrapped his soul. To find
methods of bringing it into subjection was the task of the Christian
Church for centxiries. In the Vatican Gallery of Inscriptions is a
stone slab with the single word "Stercorife," and below, the Christian
symbol. It might serve as a motto for the Middle Ages, during which,
to quote St. Paul, all things were "counted dung but to win Christ."
In this attitude of mind the wisdom of the Greeks was not simply
foolishness, but a stumblingblock in the path. Knowledge other than
that which made a man "wise unto salvation" was useless. All that
was necessary was contained in the Bible or taught by the Church.
This simple creed brought consolation to thousands and illumined the
lives of some of the noblest of men. But, "in seeking a heavenly home
man lost his bearings upon earth." Let me commend for your reading
Taylor's "Mediaeval Mind."^ I cannot judge of its scholarship, which
I am told by scholars is ripe and good, but I can judge of its useful-
ness for anyone who wishes to know the story of the mind of man in
Europe at this period. Into the content of mediaeval thought only a
mystic can enter with full sympathy. It was a needful change in the
evolution of the race. Christianity brought new ideals and new mo-
tives into the lives of men. The world's desire was changed, a desire
for the Kingdom of Heaven, in the search for which the lust of the
flesh, the lust of the eye and the pride of life were as dross. A master-
motive swayed the minds of sinful men and a zeal to save other souls
occupied the moments not devoted to the perfection of their own. The
new dispensation made any other superfluous. As Tertullian said:
Investigation since the Gospel is no longer necessary. (Dannemann,
Die Naturw., I, p. 214.) The attitude of the early Fathers toward
the body is well expressed by Jerome. "Does your skin roughen
without baths ? Who is once washed in the blood of Christ needs not
wash again." In this unfavorable medium for its growth, science
was simply disregarded, not in any hostile spirit, but as unnecessary.^

1 H. O. Taylor: The Mediaeval Mind, 2 vols., Macmillan Co., New York, 1911. [New edition,
1930.]

zibid.. Vol. I, p. 13:

"Under their action [the Christian Fathers] the peoples of Western Europe, from the eighth
to the thirteenth century, passed through a homogeneous growth, and evolved a spirit different
from that of any other period of history — a spirit which stood in awe before its monitors

86 THE EVOLUTION OF MODERN MEDICINE

And a third contributing factor was the plague of the sixth century,
which desolated the whole Roman world. On the top of the grand
mausoleum of Hadrian, visitors at Rome see the figure of a gilded
angel with a drawn sword, from which the present name of the Castle
of St. Angelo takes its origin. On the twenty-fifth of April, 590,
there set out from the Church of SS. Cosmas and Damian, already
the Roman patron saints of medicine, a vast procession, led by St.
Gregory the Great, chanting a seven- fold litany of intercession against
the plague. The legend relates that Gregory saw on the top of
Hadrian's tomb an angel with a drawn sword, which he sheathed as
the plague abated.

Galen died about 200 A. D.; the high-water mark of the Renais-
sance, so far as medicine is concerned, was reached in the year 1542.
In order to traverse this long interval intelligently, I will sketch
certain great movements, tracing the currents of Greek thought,
setting forth in their works the lives of certain great leaders, until we
greet the dawn of our own day.

After flowing for more than a thousand years through the broad
plain of Greek civilization, the stream of scientific medicine which we
have been following is apparently lost in the morass of the Middle
Ages; but, checked and blocked like the White Nile in the Soudan,
three channels may be followed through the weeds of theological and
philosophical speculation.

SOUTH ITALIAN SCHOOL

A WIDE stream is in Italy, where the "antique education never
stopped, antique reminiscence and tradition never passed away, and
the literary matter of the pagan past never faded from the conscious-
ness of the more educated among the laity and clergy."' Greek was
the language of South Italy and was spoken in some of its eastern
towns until the thirteenth century. The cathedral and monastic

divine and human, and deemed that knowledge was to be drawn from the storehouse of the
past; which seemed to rely on everything except its sin-crushed self, and trusted everything
except its senses; which in the actual looked for the ideal, in the concrete saw the symbol, in
the earthly Church beheld the heavenly, and in fleshly joys discerned the devil's lures; which
lived in the unreconciled opposition between the lust and vain-glory of earth and the attain-
ment of salvation; which felt life's terror and its pitifulness, and its eternal hope; around
which waved concrete infinitudes, and over which flamed the terror of darkness and the
Judgment Day."
3H. O. Taylor: The MediiEval Mind, Vol. I, p. 351.

SOUTH ITALIAN SCHOOL

87

schools served to keep alive the ancient learning. Monte Casino stands
pre-eminent as a great hi^^e of students, and to the famous Regula of
St. Benedict' we are indebted for the preservation of many precious
manuscripts.

The Norman Kingdom of South Italy and Sicily was a meeting
ground of Saracens, Greeks and Lombards. Greek, Arabic and
Latin were in constant use among the people of the capital, and Sicil-
ian scholars of the twelfth century translated directly from the Greek.

FIG. 32.
Salernum, Italy.

The famous "Almagest" of Ptolemy, the most important work of
ancient astronomy, was translated from a Greek manuscript, as early
as 1160, by a medical student of Salerno."

About thirty miles southeast of Naples lay Salernum, which for
centuries kept alight the lamp of the old learning, and became the
centre of medical studies in the Middle Ages ; well deserving its name
of "Civitas Hippocratica." The date of foundation is uncertain, but

4De Renzi: Storia Documentata della Scuola Medica di Salerno, 2d ed., Napoli, 1857,

Chap. V.

5 Haskins and Lockwood: Harvard Studies in Classical Philology, 1910, XXI, pp. 75-102.

88 THE EVOLUTION OF MODERN MEDICINE

Salernitan physicians are mentioned as early as the middle of the
ninth century, and from this date until the rise of the universities it
was not only a great medical school, but a popular resort for the sick
and wounded. As the scholar says in Longfellow's "Golden Legend" :

Then at every season of the year

There are crowds of guests and travellers here ;

Pilgrims and mendicant friars and traders

From the Levant, with figs and wine,
And bands of wounded and sick Crusaders,

Coming back from Palestine.

There were medical and surgical clinics, foundling hospitals. Sisters
of Charity, men and women professors — among the latter the famous
Trotula — and apothecaries. Dissections were carried out, chiefly
upon animals, and human subjects were occasionally used. In the
eleventh and twelfth centuries, the school reached its height, and that
remarkable genius, Frederick II, laid down regulations for a pre-
liminary study extending over three years, and a course in medicine
for five j^ears, including surgery. Fee tables and strict regulations as
to practice were made; and it is specifically stated that the masters
were to teach in the schools, theoretically and practical^, under the
authority of Hippocrates and Galen. The literature from the school
had a far-reaching influence. One book on the anatomy of the pig
illustrates the popular subject for dissection at that time.* The
writings, which are numerous, have been collected by De Renzi.^

The "Antidotarium" of Nicolaus Salernitanus, about 1100, became
the popular pharmacopoeia of the Middle Ages, and many modern
preparations may be traced to it.

The most prominent man of the school is Constantinus Africanus, 1/
a native of Carthage, who, after numerous journeys, reached Saler-
num about the middle of the eleventh century. He was familiar with
the works both of the Greeks and of the Arabs, and it was largely
through his translations that the works of Rhazes and Avicenna
became known in the West.

One work above all others spread the fame of the school — the

8 " And dissections of the bodies of swine

As likest tlie human form divine." — Golden Legend.
T S. de Renzi: Collectio Salernitana, S vols., Naples, 1852-1859; P. Giacosa: Magistri Saler-
nitani, Turin, 1901.

SOUTH ITALIAN SCHOOL 89

Regimen Sanitatis, or Flos Medicinse as it is sometimes called, a poem
on popular medicine. It is dedicated to Robert of Normandy, who
had been treated at Salernum, and the lines begin: "Anglorum regi
scripsit schola tota Salerni ..." It is a hand-book of diet and house-
hold medicine, with many shrewd and taking sayings which have

Cincipit Regime ranitatisSaletiursndcxccUetifliimu pro cofcrua
done fanicatis totius humani generis putiLiTimu:necn6 amagiftro
Arnaldo dc Villa noaa Carhcliano omniu medico^ uiuemiii gcma
UU'licertac Pm omniu antique^ picdicD^ do^rina u^anrcr rxpo/
fitii;nouiu-r corrrdlu ac emcndatu p rgregifi'imos ac mtdicio^ ar/
tis pericidltnos doi!tores Moncirpedulaiii rcgcntcs.ADno,M.ci:cc.
Ixxx.pdidlo loco adhi mora rrahcntes.

Ginclibcllastft

ANglojiregirctipfitfcbolatorafalerni tditusadoaori/
Si uisicolumein uis te rcddcrc fanii bus Salnniinli>
. , Curas rollc gcaucs^rafci ercdr^phanu bus in quo infcri

» Parce mrrc^ecnatoparilnio littibi uanu buiic'niallatc di

I Surgere poft cpulasifcninn fiigc n-.cridianti ucrrajicorcrua/
N5mi(ftu rerinejncccomprimcforcitfranu. docfanitarishu,!
.^Harcbcncfifcrucsituiongoieporcuiues. manf.Etcditusc'

iiic liber ad ufu3
Regis Anglif.Etin textu Icfloauaorponitoao donimeta gniba
procoferuarioel^irarisidcqbusponcarpaiircrpordinedrtcrnii/
nabic .Prim ii ergo documecti eft ^ hotfanusuoles uiucre:dcbctab
coremoueregranesairas.Nacurfex/;ecatcorpa:exquotri(lific5t
fpCis uitales;m6 fpiistriftes exiiccac olTa.Ecfub ifto documero cda
coprcbedi debet irifticif q fifr corpora exiiccat K infrigidant ma/
ai SC exbrnuacione inducuticor ftringi3[;6C fpiim obtcnebrat:inge
niii ebetatiSC rone ipcdiiitiiudiciu obfcuratjet memoria obtijdiic.
Vcriitan^ aliqui pingues K carnoii funt fpiSs adeo nobilcs-K calii/
doshritesq,cisinterdu bontrcflcri(lari;utrpiricuscalor cbiCctur:
BC carpus aliqualitcr maccrclf.Sccundu documcntti eft noli irafi i( "^
Primo qa ira fifr corpora exficcant;cu ipfa fummf fingula mcbra
fupcale&ciat. Nimia autc calcfaflio ficcitatc inducit:t<ne Auie.r.

A ii

FIG. 33.
Title-page of Regimen Sanitatis Salerni (1480).

passed into popular use, such as "Joy, temperance and repose slam
the door on the doctor's nose." A full account of the work and the
various editions of it is given by Sir Alexander Croke,^ and the Fin-
layson lecture {Glasgow Medical Journal, 1908) by Dr. Norman
Moore gives an account of its introduction into the British Isles.

8 Regimen Sanitatis Salernitanum ; a Poem on the Preservation of Health in Rhyming Latin
Verse, Oxford, D. A. Talboys, 1830.

90 THE EVOLUTION OF MODERN MEDICINE

BYZANTINE MEDICINE

The second great stream which carried Greek medicine to modern
days runs through the Eastern Empire. Between the third century
and the fall of Constantinople there was a continuous series of Byzan-

fVt « \ 1 X ( I \< , , .

' n 1 1 »t|x ■(. v\UTOi,>ft4l-.rt iJ,
■'-• I .v'.'.Arni!»i<iT»|'OAiji,l

wiK loifHiin-.rroUi-un-jk'liv'^
>V> i.ri I B|>iKi.>i<. <?r.p.)i-ni<«|fe
■iN.i..r<)oK;io-iHCii^li><^»^«j,

uxuvi.iGTXM.CoX'^AdV; .: .
'"■|>i;MMOCt-'- ^1 ,, -y

,;-„?*'^'«'''<'>"-''"'

-, ., '>J*7«^ - ^^>

FIG. 34.
Fifth century drawina; from Anicia Juliana ]\IS. of Dioscorides.

tine physicians whose inspiration was largelj^ derived from the old
Greek sources. The most distinguished of these was Oribasius, a
voluminous compiler, a native of Pergamos and so close a follower of
his great townsman that he has been called "Galen's ape." He left
many works, an edition of which was edited by Bussemaker and
Daremberg. Many facts relating to the older writers are recorded in
his writings. He was a eontemporarj^, friend as well as the physician,

ARABIAN MEDICINE 91

of the Emperor Julian, for whom he prepared an encyclopaedia of
the medical sciences.

Other important Byzantine writers were Aetius and Alexander of
Tralles, both of whom were strongly under the influence of Galen and
Hippocrates. Their materia medica was based largely upon Dios-
corides.

From Byzantium we have the earliest known complete medical
manuscript, dating from the sixth century — a work of Dioscorides —
one of the most beautiful in existence. It was prepared in the fifth
century for Anicia Juliana, daughter of the Emperor of the East, and
is now one of the great treasures of the Imperial Library at Vienna."
From those early centuries till the fall of Constantinople there is very
little of interest medically. A few names stand out prominently, but
it is a blank period in our records. Perhaps one man may be men-
tioned, as he had a great influence on later ages — Actuarius, who lived
about 1300, and whose book on the urine laid the foundation of much
of the popular uroscopy and water-casting that had such a vogue in the
sixteenth and seventeenth centuries. His work on the subject passed
through a dozen Latin editions, but is best studied in Ideler's "Physici
et medici Greeci minores" (Berlin, 1841 ) .

The Byzantine stream of Greek medicine had dwindled to a very
tiny rill when the fall of Constantinople (1453) dispersed to the West
many Greek scholars and many precious manuscripts.

ARABIAN MEDICINE

The third and by far the strongest branch of the Greek river reached
the West after a remarkable and meandering course. The map before
you (Fig. 35) shows the distribution of the Graeco-Roman Christian
world at the beginning of the seventh century. You will notice that
Christianity had extended far eastwards, almost to China. Most of
those eastern Christians were Nestorians and one of their important
centres was Edessa, whose school of learning became so celebrated.
Here in the fifth century was built one of the most celebrated
hospitals of antiquity.

Now look at another map (Fig. 36) showing the same countries

9 It has been reproduced by Scatone de Vries, Leyden, 1905, Codices graeci et latini
photographice depicti, Vol. X.

o

o
S

o
o

a;

T3

e
o

3

0)

TO

o

p

13

01

u

a

0)

a

-a

a

s

ll>

a

01

S

s

o
o

Ir-i .h -S

ft
S

0)

0)

03
u

o
1 I

03

cn

0)

-p a

O 03
0) 1 — I

94 THE EVOLUTION OF MODERN MEDICINE

about a century later. No such phenomenal change ever was made
within so short space of time as that which thus altered the map of
Asia and Europe at this period. Within a century, the Crescent had
swept from Arabia through the Eastern Empire, over Egypt, North
Africa and over Spain in the West, and the fate of Western Europe
hung in the balance before the gates of Tours in 732. This time the
barbaric horde that laid waste a large part of Christendom were a
people that became deeply appreciative of all that was best in Grseco-
Roman civilization and of nothing more than of its sciences. The cul-
tivation of medicine was encouraged by the Arabs in a very special
way. Anyone wishing to follow the history of the medical profession
among this remarkable people will find it admirably presented in
Lucien Leclerc's "Histoire de la medecine arabe" (Paris, 1876). An
excellent account is also given in Freind's well-known "History of
Medicine" (London, 1725-1726). Here I can only indicate very
briefly the course of the stream and its freightage.

With the rise of Christianity, Alexandria became a centre of bitter
theological and political factions, the story of which haunts the
memory of anyone who was so fortunate as to read in his youth Kings-
ley's "Hypatia." These centuries, with their potent influence of neo-
platonism on Christianity, appear to have been sterile enough in
medicine. I have already referred to the late Greeks, Aetius and
Alexander of Tralles. The last of the Alexandrians was a remark-
able man, Paul of iEgina, a great name in medicine and in surgery,
who lived in the early part of the seventh century. He also, like
Oribasius, was a great compiler. In the year 640, the Arabs took
Alexandria, and for the third time a great library was destroyed in
the "first city of the West." Leclerc brings out a point not referred
to particularly in the histories, viz.^ that shortly after the conquest of
Egypt, Greek works were translated into Arabic, particularly certain
of Galen's books on medicine, and chemical writings, which appear to
have laid the foundation of Arabian knowledge on this subject.

Through Alexandria then was one source : but the special develop-
ment of the Greek science and of medicine took place in the ninth
century under the Eastern Caliphates. Let me quote here a couple of
sentences from Leclerc (Tome I, pp. 91-92) :

"The world has but once witnessed so marvellous a spectacle as that
presented by the Arabs in the ninth century. This pastoral people,

ARxlBIAN MEDICINE 95

whose fanaticism had suddenly made them masters of half of the
world, having once founded their empire, immediately set themselves
to acquire that knowledge of the sciences which alone was lacking to
their greatness. Of all the invaders who competed for the last remains
of the Roman Empire they alone pursued such studies; while the
Germanic hordes, glorying in their brutality and ignorance, took a
thousand years to re-unite the broken chain of tradition, the Arabs
accomplished this in less than a century. They provoked the com-
petition of the conquered Christians — a healthy competition which
secured the harmony of the races.

"At the end of the eighth century, their whole scientific posses-
sions consisted of a translation of one medical treatise and some books
on alchemy. Before the ninth century had run to its close, the Arabs
were in possession of all the science of the Greeks ; they had produced
from their own ranks students of the first order, and had raised among
their initiators men who, without them, would have been groping in
the dark; and they showed from this time an aptitude for the exact
sciences, which was lacking in their instructors, whom they hence-
forward surpassed."

It was chiefly through the Nestorians that the Arabs became
acquainted with Greek medicine, and there were two famous families
of translators, the Bakhtishuas and the Mesues, both Syrians, and
probably not very thoroughly versed in either Greek or Arabic. But
the prince of translators, one of the finest figures of the century, was
Honein, a Christian Arab, born in 809, whose name was Latinized as
Joannitius. "The marvellous extent of his works, their excellence,
their importance, the trials he bore nobly at the beginning of his
career, everything about him arouses our interest and sympathy. If
he did not actually create the Oriental renaissance movement, certainly
no one played in it a more active, decided and fruitful part."^" His
industry was colossal. Pie translated most of the works of Hippoc-
rates and Galen, Aristotle and many others. His famous "Introduc-
tion" or "Isagoge," a very popular book in the Middle Ages, is a
translation of the "Microtegni" of Galen, a small hand-book, of which
a translation is appended to Cholmeley's "John of Gaddesden.""
The first printed edition of it appeared in 1475 [see page 127] at
Padua.

loLeclerc: Histoire de la mddecine arabe, Tome I, p. 139.
11 Oxford-, Clarendon Press, 1912, pp. 136-166.

96 THE EVOLUTION OF MODERN MEDICINE

Sragoficljftjnnitai

The Mesues also did great work,
and their translations, particularly
those of the younger Mesue, were
widely distributed in manuscript and
were early printed (Venice, 1471).
The Canones were frequently re-
printed, even as late as the seven-
teenth century.

Leclerc gives the names of more
than one hundred known translators
who not only dealt with the physi-
cians but with the Greek philoso-
phers, mathematicians and astrono-
mers. The writings of the physicians
of India and of Persia were also
translated into Arabic.

But close upon the crowd of trans-
lators wh^ introduced the learning of
Greece to the Arabians came origi-
nal observers of the first rank, to a
few only of which time will allow me to refer, Rhazes, so called
from the name of the town in which he was born, was educated at the
great hospital at Bagdad in the second half of the ninth century.
With a true Hippocratic spirit he made many careful observations on
disease, and to him we owe the first accurate account of smallpox,^
which he differentiated from measles. This work was translated for
the old Sydenham Society by W. A. Greenhill (1848), and the de-
scription given of the disease is well worth reading. He was a man of
strong powers of observation, good sense and excellent judgment.
His works were very popular, particularly the gigantic "Contin-
ens," one of the bulkiest of incunabula. The Brescia edition, 1486,
a magnificent volume, extends over 588 pages and it must weigh more
than seventeen pounds. It is an encyclopaedia filled with extracts from
the Greek and other writers, interspersed with memoranda of his own
experiences. His "Almansor" was a very popular text-book, and one
of the first to be printed. Book IX of "Almansor" (the name of the
prince to whom it was addressed) with the title "De fegritudinibus a
capite usque ad pedes," was a very favorite mediaeval text-book. On

FIG. 37.
Page from the Isagoge of

Joannitlus.
(In Articella, Venice, 1487.)

FIG. 38.
Avicenna.

98 THE EVOLUTION OF MODERN MEDICINE

account of his zeal for study Rhazes was known as the "Experi-
mentator."

The first of the Arabians, known throughout the Middle Ages as
the Prince, the rival, indeed, of Galen, was the Persian Ibn Sina,
better known as Avicenna, one of the greatest names in the history of
medicine. Born about 980 A. D. in the province of Khorasan, near
Bokhara, he has left a brief autobiography from which we learn some-
thing of his early years. He could repeat the Koran by heart when
ten years old, and at twelve he had disputed in law and in logic. So
that he found medicine was an easy subject, not hard and thorny like
mathematics and metaphysics ! He worked night and day, and could
solve problems in his dreams. "When I found a difficulty," he says,
"I referred to my notes and prayed to the Creator. At night, when
weak or sleepy, I strengthened myself with a glass of wine."^^ He
was a voluminous writer to whom scores of books are attributed, and
he is the author of the most famous medical text-book ever written.
fit is safe to say that the "Canon" was a medical bible for a longer
period than any other work. It "stands fox the epitome of all preced-
ent development, the final codification of all Grsco- Arabic medicine.
It is a hierarchy of laws liberally illustrated by facts which so in-
geniously rule and are subject to one another, stay and uphold one
another, that admiration is compelled for the sagacity of the great
organiser who, with unparalleled power of systematisation, collecting
his material from all sources, constructed so imposing an edifice of
fallacy. Avicenna, according to his lights, imparted to contemporary
medical science the appearance of almost mathematical accuracy,
whilst the art of therapeutics, although empiricism did not wholly lack
recognition, was deduced as a logical sequence from theoretical
(Galenic and Aristotelian) premises. Is it, therefore, matter for sur-
prise that the majority of investigators and practitioners should have
fallen under the spell of this consummation of formalism and should
have regarded the 'Canon' as an infallible oracle, the more so in that the
logical construction was impeccable and the premises, in the light of
contemporary conceptions, passed for incontrovertible axioms?"^'

Innumerable manuscripts of it exist: of one of the most beautiful,
which is in the Bologna Library, I give an illustration (Fig. 39).

12 Withington: Medical History, London, 1894, pp. 151-152.

13 Neuburger: History of Medicine, Vol. I, pp. 368-369.

FIG. 39.
Illuminated illustration from a Hebrew MS. of Avicenna in the Bologna Library.

100 THE EVOLUTION OF MODERN MEDICINE

1' -UiiW

P^ ■ .IrVLtJI'. -•;= ,,7.

P^' The work was first printed in 1472

and there are numberless editions,

the last in 1663. Avicenna was

I ."^ .>,<r >,r -7 ,'^- *>< not only a successful writer, but

I 1^ ' , MlA<.\\l..:\.\\ d<\\ ' ^. \^ „ ^, ' ,

the prototype oi the successtul

physician who was at the same
time statesman, teacher, philoso-
pher and literary man. Rumor
has it that he became dissipated,
and a contemporary saying was
that all his philosophy could not
make him moral, nor all his physic

l?%a£^?^' " Vl«* teach him to preserve his health.

i ' S ^ a ^'' ><:? ? r -^' He enjoyed a great reputation as

f M^^i W'Jy' A'J""^ a poet. I reproduce (Fig. 40) a

page of a manuscript of one of his
poems, which we have in the Bod-
leian Library. Prof. A. V. W.
Jackson says that some of his
verse is peculiarly Khayyamesque,

though he antedated Omar by a century. That "large Infidel" might

well have written such a stanza as

From Earth's dark centre unto Saturn's Gate
I've solved all problems of this world's Estate,
From every snare of Plot and Guile set free.
Each bond resolved, saving alone Death's Fate.

FIG. 40.

Page of MS. of Avicenna 's poems in
the Bodleian Library.

His hymn to the Deity might have been written by Plato and rivals
the famous one of Cleanthes." A casual reader gets a very favorable
impression of Avicenna. The story of his dominion over the schools
in the Middle Ages is one of the most strildng in our history. Perhaps
we feel that Leclerc exaggerates when he saj^s: "Avicenna is an intel-
lectual phenomenon. Never perhaps has an example been seen of so
precocious, quick and wide an intellect extending and asserting itself
with so strange and indefatigable an activity." The touch of the man
never reached me until I read some of his mystical and philosophical

iJ "L'hymne d'Avicenne" in: L,'&\&gie du Tograi, etc., par P. Vattier, Paris, 1660.

ARABIAN MEDICINE 101

writings translated by Mehren/' It is Plato over again. The beauti-
ful allegory in which men are likened to birds snared and caged until
set free by the Angel of Death might be met with anywhere in the
immortal Dialogues. The tractate on Love is a commentary on the
Symposium; and the essay on Destiny is Greek in spirit without a
trace of Oriental fatalism, as you maj^ judge from the concluding
sentence, which I leave you as his special message: "Take heed to the
limits of your capacity and you will arrive at a knowledge of the truth.

How true is the saying: — Work
ever and to each will come that
measure of success for which Na-
ture has designed him." Avicenna
died in his fifty-eighth year. When
he saw that physic was of no avail,
resigning himself to the inevitable,
he sold his goods, distributed the
money to the poor, read the Koran
through once every three days, and
FIG. 41. died in the holy month of Ramadan.

Tomb of Avicenna at Hamadan. ^is tomb at Hamadan, the ancient

Ecbatana, still exists, a simple
brickwork building, rectangular in
shape, and surrounded by an unpretentious court. It was restored
in 1877, but is again in need of repair. The illustration here shown
(Fig. 41) is from a photograph sent by Dr. Neligan of Teheran.
Though dead, the great Persian has still a large practice, as his tomb
is much visited by pilgrims, among whom cures are said to be not
uncommon.

The Western Caliphate produced physicians and philosophers
almost as brilliant as those of the East. Remarkable schools of medi-
cine were founded at Seville, Toledo and Cordova. The most famous
of the professors were Averroes, Albucasis and Avenzoar. Albucasis
was "the Arabian restorer of surgery." Averroes, called in the Middle
Ages "the Soul of Aristotle" or "the Commentator," is better known
today among philosophers than physicians. On the revival of Moslem
orthodoxy he fell upon evil days, was persecuted as a free-thinker,
and the saying is attributed to him — "Sit anitna mea cum pMlosopMs."

15 Traitfe mystiques d'Abou Ali al-Hosain b. Abdallah b. Sina ou d'Avicenne par M. A. F.
Mehren, Leyden, E. J. Brill, Fasc. I-IV, 1889-1899.

\

102 THE EVOLUTION OF MODERN MEDICINE

Arabian medicine had certain very definite characteristics : the basis
was Greek, derived from translations of the works of Hippoci'ates
and Galen. No contributions were made to anatomy, as dissections
were prohibited, nor to physiology, and the pathology was practically
that of Galen. Certain new and important diseases were described;
a number of new and active remedies were introduced, chiefly from the
vegetable kingdom. The Arabian hospitals were well organized and
were deservedly famous. No such hospital exists today in Cairo as
that which was built by al-Mansur Gilafun in 1283. The description
of it by Makrizi, quoted by Neuburger," reads like that of a twentieth
century institution with hospital units.

^ It was in the domain of chemistrj^ that the Arabs made the greatest
"advances. You may remember that, in Egypt, chemistry had already
made considerable strides, and I alluded to Prof. Elliot Smith's view
that one of the great leaps in civilization was the discovery in the Nile
Valley of the metallurgy of copper. In the brilliant period of the
Ptolemies, both chemistry and pharmacology were studied, and it
seems not improbable that, when the Arabs took Alexandria in the
year 640, there were still many workers in these subjects.

The most famous of those early Arabic writers is the somewhat
mythical Geber, who lived in the first half of the eighth century, and
whose writings had an extraordinary influence throughout the Middle
Ages. The whole story of Geber is discussed by Berthelot in his
"La chimie au moyen age" (Paris, 1896).

18 "I have founded this institution for my equals and for those beneath me, it is intended for
rulers and subjects, for soldiers and for the emir, for great and small, freemen and slaves,
men and women." "He ordered medicaments, physicians and everything else that could be
required by anyone in any form of sickness; placed male and female attendants at the disposal
of the patients, determined their pay, provided beds for patients and supplied them with every
kind of covering that could be required in any complaint. Every class of patient was accorded
separate accommodation: the four halls of the hospital were set apart for those with fever and
similar complaints ; one part of the building was reserved for eye-patients, one for the wounded,
one for those suffering from diarrhoea, one for women; a room for convalescents was divided
into two parts, one for men and one for women. Water was laid on to all these departments.
One room was set apart for cooking food, preparing medicine and cooking syrups, another for
the compounding of confections, balsams, eye-salves, etc. The head-physician had an apartment
to himself wherein he delivered medical lectures. The number of patients was unlimited, every
sick or poor person who came found admittance, nor was the duration of his stay restricted,
and even those who were sick at home were supplied with every necessity." — Makrizi.

"In later times this hospital was much extended and improved. The nursing was admirable
and no stint was made of drugs and appliances; each patient was provided with means upon
leaving so that he should not require immediately to undertake heavy work." Neuburger:
History of Medicine, Vol. I, p. 378.

ARABIAN MEDICINE 103

The transmission of Arabian science to the Occident began with
the Crusades, though earher a filtering of important knowledge in
mathematics and astronomy had reached Southern and Middle
Europe through Spain. Among the translators several names stand
out prominently. Gerbert, who became later Pope Sylvester II, is
said to have given us our present Arabic figures. You may read the
story of his remarkable life in Taylor," who says he was "the first mind
of his time, its greatest teacher, its most eager learner, and most uni-
versal scholar." But he does not seem to have done much directly for
medicine.

The Grseco-Arabic learning passed into Europe through two
sources. As I have already mentioned, Constantinus Africanus, a
North African Christian monk, widely travelled and learned in lan-
guages, came to Salernum and translated many works from Arabic
into Latin, particularly those of Hippocrates and Galen. The "Pan-
tegni" of the latter became one of the most popular text-books of the
Middle Ages. A long list of other works which he translated is given
by Leclerc. It is not unlikely that Arabic medicine had already found
its way to Salernum before the time of Constantine, but the influence
of his translations upon the later Middle Ages was very great.

The second was a more important source — through the Latin trans-
lators in Spain, particularly in Toledo, where, from the middle of
the twelfth till the middle of the thirteenth century, an extraordinary
number of Arabic works in philosophy, mathematics and astronomy
were translated. Among the translators, Gerard of Cremona is
prominent, and has been called the "Father of Translators." He was
one of the brightest intelligences of the Middle Ages, and did a work
of the first importance to science, through the extraordinary variety of
material he put in circulation (licclerc). Translations, not only of
the medical writers, but of an indiscriminate crowd of authors in
philosophy and general literature, came from his pen. He furnished
one of the first translations of the famous "Almagest" of Ptolemy,
which opened the eyes of his contemporaries to the value of the
Alexandrian astronomy." Leclerc gives a list of seventy-one works
from his hand.

17 The Mediaeval Mind, Vol. I, p. 280.

IS For an account of that remarkable work see the German translation by Manitius, Leipzig,
1912.

V

104 THE EVOLUTION OF MODERN MEDICINE

Many of the translators of the period were Jews, and many of the
works were translated from Hebrew into Latin. For years Arabic
had been the learned language of the Jews, and in a large measure it
was through them that the Arabic knowledge and the translations
passed into South and Central Europe.

The Arab v/riter whose influence on mediaeval thought was the most
profound was Averroes, the great commentator on Aristotle.

THE RISE OF THE UNIVERSITIES

The most striking intellectual phenomenon of the thirteenth century
is the rise of the universities. The story of their foundation is fully
stated in Rashdall's great work ( Universities of Europe in the Middle
Ages, Oxford, 1895) . Monastic and collegiate schools, seats of learn-
ing like Salernum, student guilds as at Bologna, had tried to meet the
educational needs of the age. The word "university" literally means
an association, and was not at first restricted to learned bodies. The
origin appears to have been in certain guilds of students formed for
mutual protection associated at some place speciall}^ favorable for
study — the attraction generally being a famous teacher. The Uni-
versity of Bologna grew up about guilds formed by students of law,
and at Paris, early in the twelfth century, there were communities of
teachers, chiefly in philosophy and theolog5^ In this way arose two
different types of mediaeval university. The universities of Northern
Italy were largely controlled by students, who were grouped in dif-
ferent "nations." They arranged the lectures and had control of the
appointment of teachers. On the other hand, in the universities
founded on the Paris model the masters had control of the studies,
though the students, also in nations, managed their own affairs.

Two universities have a special interest at this period in connection
with the development of medical studies, Bologna and JNIontpellier.
At the former the study of anatomy was revived. In the knowledge of
the structure of the human body no advance had been made for more
than a thousand years — since Galen's day. In the process of trans-
lation from Greek to Syriac, from Syriac to Arabic, from Arabic to
Hebrew, and from Hebrew or Arabic to Latin, both the form and
thought of the old Greek writers were not infrequently confused and
often even perverted, and Galen's anatomy had suffered severely in

THE RISE OF THE UNIVERSITIES

105

the transmission. Our earliest knowledge of the teaching of medicine
at Bologna is connected with a contemporary of Dante, Taddeo Alde-
rotti, who combined Arabian erudition with the Greek spirit. He
occupied a position of extraordinary prominence, was regarded as the

m lEmebam g
joctozcmelaflat

FIG. 42.

Title-page of Anathomia of Mundinus.

{Melerstat edition.)
(Printed at Leipzig, circa 14.93.)

first citizen of Bologna and a public benefactor exempt from the
payment of taxes. That he should have acquired wealth is not sur-
prising if his usual fees were at the rate at which he charged Pope
Honorius IV, i.e., two hundred florins a day, besides a "gratification"
of six thousand florins.

The man who most powerfully influenced the study of medicine in

106 THE EVOLUTIOjST OF MODERN MEDICINE

Bologna was Mundinus, the first modern student of anatomy. We
have seen that at the school of Salernum it was decreed that the hu-
man body should be dissected at least once every five years, but it was
with the greatest difficulty that permission was obtained for this pur-
pose. It seems probable that under the strong influence of Taddeo
there was an occasional dissection at Bologna, but it was not until
Mundinus (professor from 1306 to 1326) took the chair that the study
of anatomy became popular. The bodies were usually those of con-
demned criminals, but in the year 1319 there is a record of a legal
procedure against four medical students for body-snatching — the fii-jit
record, as far as I know, of this gruesome practice. In 1316, Mun-
dinus issued his work on anatomy, which served as a text-book for
more than two hundred years. He quotes from Galen the amusing
reasons why a man should write a book: "Firstly, to satisfy his own
friends; secondly, to exercise his best mental powers; and thirdly, to
be saved from the oblivion incident to old age." Scores of manu-
scripts of his work must have existed, but they are now excessively
rare in Italy. The book was first printed at Pavia in 1478, in a small
folio without figures. It was very often reprinted in the fifteenth and
sixteenth centuries. The quaint illustration (Fig. 42) shows us the
mediaeval method of teaching anatomy: the lecturer sitting on a chair
reading from Galen, while a barber surgeon, or an "Ostensor," opens
the cavities of the body.

I have already referred to the study of medicine by women at
Salernum. Their names are also early met with in the school of
^Bologna. Mundinus had a valuable assistant, a young girl, Alessan-
dra Giliani, an enthusiastic dissector, who is said to have been the first
to practise the injection of the blood vessels with colored liquids. She
died, consumed by her labors, at the early age of nineteen, and her
monument is still to be seen.

Bologna honored its distinguished professors with magnificent
tombs, sixteen or seventeen of which, in a wonderful state of preserva-
tion, may still be seen in the Civic Museum. That of Mundinus also
exists — a sepulchral bas-relief on the wall of the Church of San
Vitale at Bologna."

The other early mediaeval university of special interest in medicine

19 For these figures and for points relating to the old school at Bologna see F. G. Cavazza:
Le Scuole dell' antico Studio Bolognese, Milano, 1896.

THE RISE OF THE UNIVERSITIES 107

is that of MontpellierK With it are connected three teachers who have
left great names in our story — Arnold of Villanova, Henri de Monde-
ville and Guy de Chauliac. The city was very favorably situated
not far from the Spanish border, and the receding tide of the Arab
invasion in the eighth century had left a strong Arabic influence in that
province. The date of the origin of the university is uncertain, but
there were teachers of medicine there in the twelfth century, though it
was not until 1289 that it was formally founded by a papal bull.

r* et6m'nfirm wEorcs aiimiuoc

leiTf^ (ERof CB1?!BEIWCC(RE ©eWEITES PEOEREifflC

BRSJ uw| jrmmTJ PfmREc(Bfls.afflnofip«fDEPTc

,iHa| ©3»:|(X)fflpJlV^P0Cnfl'n.S'EMi1!WiRjlRiP0f?ESEPTa

kPM.:^ IfffnismEros.-ERCEnTii^R.Btsxi? nonejiis- .

FIG. 43.
Tablet to Mundinus (Church of San Vitale, Bologna).

Arnold of Villanova was one of the most prolific writers of the
Middle Ages. He had travelled much, was deeply read in Arabic
medicine and was also a student of law and of philosophy. He was
an early editor of the Regimen Sanitatis, and a strong advocate of
diet and hygiene. His views on disease were largely those of the
Arabian physicians, and we cannot see that he himself made any very
important contribution to our knowledge ; but he was a man of strong
individuality and left an enduring mark on mediseval medicine, as one
may judge from the fact that among the first hundred medical books
printed there were many associated with his name. He was an early
heretic and constantly in trouble with the Church, though befriended
by the Popes on account of his medical knowledge. There is a Bull
of Clement V asking the bishops to search for a medical book by
Arnold dedicated to himself, but not many years later his writings
were condemned as heretical.

In Henri de Mondeville we have the typical mediaeval surgeon, and
we know his work now very thoroughly from the editions of his

108 THE EVOLUTION OF MODERN MEDICINE

"Anatomy" and "Surgery" edited by Pagel (Berlin, 1889-1892), and
the fine French edition by Nicaise (Paris, 1893). The dominant
Arabic influence is seen in that he quotes so large a proportion of these
authors, but he was an independent observer and a practical surgeon
of the first rank. He had a sharp wit and employed a bitter tongue
against the medical abuses of his day. How the Hippocratic humors
dominated practice at this time you may see at a glance from the table
prepared by Nicaise from the works of de Mondeville, (Fig. 44.)
We have here the whole pathology of the period.

TABLEAU DES HUMEURS

D'APRES H. DE MONDEVILLE

Flegme naturel.

Flegme

F. aqueux.

F. mucilagineux.

F. vitreux.

Flegme non naturel

F. gj^pseux.
F. sale.

F. doux.

F. pontique, 2 especes.
F. acide, 2 especes.

Bile naturelle. |

Bile

Bile non naturelle

B. citrine.
B. vitelline.
B. prasine.

„ f naturel.
sang

[ non naturel, 5 espece

B. aerugineuse.

B. brulee, 3 especes.

s.

,,,, T f naturelle.
Melancolie \

[ non naturelle, 6 especes.

FIG. 44.

Table of the Hippocratic Humors.

{Nicaise. )

THE RISE OF THE UNIVERSITIES

109

A still greater name in the history of this school is Guy de Chauliac,
whose works have also been edited by Nicaise (Paris, 1890). His
"Surgery" was one of the most important text-books of the late
Middle Ages. There are many manuscripts of it, some fourteen
editions in the fifteenth century and thirty-eight in the sixteenth, and
it continued to be reprinted far into the seventeenth century. He too

FIG. -t,5.

MediiPval Dissection Scene from a fourteenth century MS. of
Guy de Chauliac in MontpelKer Library.

was dominated by the surgery of the Arabs, and on nearly every page
one reads of the sages Avicenna, Albucasis or Rhazes. He lays down
four conditions necessar}'- for the making of a surgeon — the first is
that he must be learned, the second, expert, the third that he should be
clever, and the fourth that he should be well disciplined.

You will find a very discerning sketch of the relation of these two

no THE EVOLUTION OF MODERN MEDICINE

men to the history of surgery in the address given at the St. Louis
Congress in 1904 by Sir Chfford Allbutt.^" They were strong men
with practical minds and good hands, whose experience taught them
wisdom. In both there was the blunt honesty that so often character-
izes a good surgeon, and I commend to modern surgeons de Monde-
ville's saying: "If you have operated conscientiously on the rich for
a proper fee, and on the poor for charity, you need not play the monk,
nor make pilgrimages for your soul."

One other great mediaevaL physician may be mentioned, Peter of
Abano' ( a small town near Padua, famous for its baths ) . He is the
first in a long line of distinguished physicians connected with the great
school of Padua. Known as "the Conciliator," from his attempt to
reconcile the diverse views on philosophy and medicine, he had an
extraordinary reputation as a practitioner and author, the persistence
of which is well illustrated by the fact that eight of the one hundred
eighty- two medical books printed before 1481 were from his pen. He
appears to have taught medicine in Paris, Bologna and Padua. He
was a devoted astrologer, had a reputation among the people as a
magician and, like his contemporary, Arnold of Villanova, came into
conflict with the Church and appears to have been several times before
the Inquisition; indeed it is said that he escaped the stake only by a
timely death. He was a prolific commentator on Aristotle, and his
exposition of the "problems" had a great vogue. The early editions of
his texts are among the most superb works ever printed. He outlived
his reputation as a magician, and more than a century after his death
Frederick, Duke of Urbino, caused his effigies to be set up over the
gate of the palace at Padua with this inscription :

PETRUS APONUS PATAVINUS PHILOSOPHIC MEDICINCQUE

SCIENTISSIMUS, OB IDQUE, CONCILIATORIS NOMEN

ADEPTUS, ASTROLOGIC VERO ADEO PERITUS,

UT IN MAGIC SUSPICIONEM INCIDERIT,

FALSOQUE DE HCRESI POSTULATUS,

ABSOLUTUS FUERIT.=i

It is said that Abano caused to be painted the astronomical figures
in the great hall of the palace at Padua.

2oAllbutt: Historical Relations of Medicine and Surgery, London, Macmlllan Co., 1905.
21 Naud6: History of Magick, London, 1657, p. 182, or the original: Apologie pour les
grands hommes soupcjonnez de magie, e.g., ed. Amst., 1712, p. 275.

THE RISE OF THE UNIVERSITIES 111

One characteristic of mediaeval medicine is its union with theology, '
which is not remarkable, as the learning of the time was chiefly in the
hands of the clergy. One of the most popular works, the "Thesaurus
Pauperum," was written by Petrus Hispanus, afterwards Pope John
XXI. We may judge of the pontifical practice from the page here
reproduced (Fig. 46), which probably includes, under the term "iliac
passion," all the mediaeval varieties of appendicitis.

For our purpose two beacons illuminate the spirit of the thirteenth
century in its outlook on man and nature. Better than Abelard or
St. Thomas Aquinas, and much better than any physicians, Albertus
Magnus and Roger Bacon represent the men who were awake to greet
the rising of the sun of science. What a contrast in their lives and in
their works! The great Dominican's long life was an uninterrupted
triumph of fruitful accomplishment — the titanic task he set himself
was not only completed but was appreciated to the full by his own
generation — a life not only of study and teaching, but of practical
piety. As head of the order- in Germany and Bishop of Regensburg,
he had wide ecclesiastical influence; and in death he left a memory
equalled only by one or two of his centurj'^, and excelled only
by his great pupil, Thomas Aquinas. There are many Alberts in
history — the Good, the Just, the Faithful — but there is only one we
call "Magnus" and he richly deserved the name. What is his record?
Why do we hold his name in reverence today ?

Albertus Magnus was an encyclopaedic student and author, who
took all knowledge for his province. His great work and his great
ambition was to interpret Aristotle to his generation. Before his day,
the Stagirite was known only in part, but he put within the reach of
his contemporaries the whole science of Aristotle, and imbibed no
small part of his spirit. He recognized the importance of the study of
nature, even of testing it by way of experiment, and in the long years
that had elapsed since Theophrastus no one else, except Dioscorides,
had made so thorough a study of botany. His paraphrases of the nat-
ural history books of Aristotle were immensely popular, and served
as a basis for all subsequent studies. Some of his medical works had
an extraordinary vogue, particularly the "De Secretis Mulierum" and
the "De Virtutibus Herbarum," though there is some doubt as to the
authorship of the first named (but Jammy and Borgnet include it in
the collected editions of his works) . So fabulous was his learning that

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FIG. 46.
Page from the Practica or Thesaurus Pauperum of Pope John XXI (Antwerp, 1486);

THE RISE OF THE UNIVERSITIES 113

he was suspected of magic and comes in Naude's list of the wise men
who have unjustly been reputed magicians. Ferguson tells^^ that
"there is in actual circulation at the present time a chap-book . . .
containing charms, receipts, sympathetical and magical cures for man
and animals, . . . which passes under the name of Albertus." But
perhaps the greatest claim of Albertus to immortality is that he was
the teacher and inspirer of Thomas Aquinas, the man who undertook
the colossal task of fusing Aristotelian philosophy with Christian
theology, and with such success that the "angelic doctor" remains
today the supreme human authority of the Roman Catholic Church.
A man of much greater interest to us from the medical point of
view is Roger Bacon and for two reasons. More than any other
mediaeval mind he saw the need of the study of nature by a new
method. The man who could write such a sentence as this: "Experi-
mental science has three great prerogatives over other sciences; it
verifies conclusions by direct experiment ; it discovers truth which they
never othei'wise would reach ; it investigates the course of nature and
opens to us a knowledge of the past and of the future," is mentally of
our day and generation. Bacon was born out of due time, and his
contemporaries had little sympathy with his philosophy, and still less
with his mechanical schemes and inventions. From the days of the
Greeks, no one had had so keen an appreciation of what expe rimen t
meant in the development of human knowledge, and he was obsessed
with the idea, so commonplace to us, that knowledge should have its
utility and its practical bearing. "His chief merit is that he was one of
the first to point the waj^ to original research — as opposed to the
acceptance of an authority — though he himself still lacked the means
of pursuing this path consistently. His inability to satisfy this impulse
led to a sort of longing, which is expressed in the numerous passages
in his works where he anticipates man's greater mastery over nature."^^
Bacon wrote a number of medical treatises, most of which remained
in manuscript. His treatise on the "Cure of Old Age and the Preser-
vation of Youth" was printed in English in 1683.^* His authorities

22 Blbliotheca Chemica, 1906, Vol. I, p. IS.

23Dannemann: Die Naturwissenschaften in ihrer Entwicklung und in ihrem Zusammen-
hange, Leipzig, 1910, Vol. I, pp. 278-279.

24 It may be interesting to note the three causes to which he attributes old age : "As the
World waxeth old, Men grow old with it: not by reason of the Age of the World, but because
of the great Increase of living Creatures, which infect the very Air, that every way encom-

Mo GEM II A COX

y/r/// //_ / !'f/'/ hv //^///y//,/ r A/f/r/r/

FIG. 47.
Roger Bacon.

MEDI.5i]VAL MEDICAL STUDIES 115

were largely Arabian. One of his manuscripts is "On the Bad Prac-
tices of Physicians." On June 10, 1914, the eve of his birth, the
septencentenary of Roger Bacon will be celebrated by Oxford, the
university of which he is the most distinguished ornament. His un-
published MSS. in the Bodleian will be issued by the Clarendon
Press [1915-1920], and it is hoped that his unpublished medical
writings will be included.

What would have been its fate if the mind of Europe had been ready
for Roger Bacon's ferment, and if men had turned to the profitable
studies of physics, astronomy and chemistry instead of wasting cen-
turies over the scholastic philosophj^ and the subtleties of Duns
Scotus, Abelard and Thomas Aquinas? Who can say? Make no
mistake about the quality of these men — ^giants in intellect, who have
had their place in the evolution of the race; but from the standpoint
of man struggling for the mastery of this world they are like the
members of Swift's famous college "busy distilling sunshine from ^
cucumbers." I speak, of course, from the position of the natural man,
who sees for his fellows more hope from the experiments of Roger
Bacon than from the disputations of philosophy on the "Instants,
Familiaxities, Quiddities and Relations," which so roused the scorn of
Erasmus.

MEDIJSVAL MEDICAL STUDIES

It will be of interest to know what studies were followed at a mediaeval
university. At Oxford, as at most of the continental universities,
there were three degrees, those of Bachelor, Licentiate and Doctor.
The books read were the "Tegni" of Galen, the "Aphorisms" of Hip-
pocrates, the "Liber Febri" of Isaac and the "Antidotarium" of Nico-
laus Salernitanus : if a graduate in arts, six years' study in all were re-
quired, if not eight. One gets very full information on such matters
from a most interesting book, "Une Chaire de Medecine au XV^-
Siecle," by Dr. Ferrari (Paris, 1899). The University of Pavia was '^
founded in 1361, and like most of those in Italy was largely frequented
by foreigners, who were arranged, as usual, according to their na-
tionalities ; but the students do not appear to have controlled the uni-
versity quite so much as at Bologna. The documents of the Ferrari

passeth us, and Through our Negligence in ordering our Lives, and That great Ignorance of
the Properties which are in things conducing to Health, which might help a disordered way of
Living, and might supply the defect of due Government."

116 THE EVOLUTION OF MODERN MEDICINE

family, on which the work is based, tell the story of one of its mem-
bers, who was professor at Pavia from 1432 to 1472. One is sur-
prised at the range of studies in certain directions, and still more at
the absence of other subjects. A list is given of the teachers in medi-
cine for the year 1433, twenty in all, and there were special lectures

FIG. 48.

Medical Lecture at Bologna in the Middle Ages.

{From the tomb qf the physician Michele Bertalia, 1328.)

T

FIG. 49.

Mundinus Lecturing.

{From his tomb in the Church qfSan Vitale, Bologna.)

for the morning, afternoon and evening. The subjects are medicine,
practical medicine, physics, metaphysics, logic, astrology, surgery and
rhetoric: very striking is the omission of anatomy, which does not
appear in the hst even in 1467. The salaries paid were not large, so
that most of the teachers must have been in practice: four hundred
and five hundred florins was the maximum.

MEDIEVAL MEDICAL STUDIES 117

The dominance of the Arabians is striking. In 1467, special lec-
tures were given on the "Almansor" of Rhazes, and in the catalogue
of the Ferrari's library more than one half of the books are Arabian
commentaries on Greek medicine. Still more striking evidence of
their influence is found in the text-book of Ferrari, which was printed
in 1471 and had been circulated earlier in MS. In it Avicenna is
quoted more than 3000 times, Rhazes and Galen 1000, Hippocrates
only 140 times. Professor Ferrari was a man who played an impor-
tant role in the university, and had a large consultation practice. You
will be interested to know what sort of advice he gave in special cases.
I have the record of an elaborate consultation written in his own hand,
from which one may gather what a formidable thing it was to fall into
the hands of a mediaeval physician. Sir John de Calabria had a diges-
tive weakness of the stomach, and rheumatic cerebral disease, com-
bined with superfluous heat and dryness of the liver and multiplication
of choler. There is first an elaborate discussion on diet and general
mode of life ; then he proceeds to draw up certain light medicines as a
supplement, but it must have taken an extensive apothecary's shop to
turn out the twenty-two prescriptions designed to meet every possible
contingency.

One of the difficulties in the earlj^ days of the universities was to
procure good MSS. In the Paris Faculty, the records of which are
the most complete in Europe, there is an inventory for the year 1395
which gives a list of twelve volumes, nearly all by Arabian authors.^^
Franklin gives an interesting incident illustrating the rarity of
medical MSS. at this period. Louis XI, always worried about his
health, was anxious to have in his library the works of Rhazes. The
only copy available was in the library of the medical school. The
manuscript was lent, but on excellent security, and it is nice to know
that it was returned.

It is said that one of the special advantages that Montpellier had
over Paris was its possession of so many important MSS., particu-
larly those of the Arabian writers. Many "Compendia" were written
containing extracts from various writers, and no doubt these were
extensively copied and lent or sold to students. At Bologna and
Padua, there were regulations as to the price of these MSS. The
university controlled the production of them, and stationers were

25 Franklin: Recherches sur la Bibliothfeque de la Facult6 de M^decine de Paris, 1864.

A

118 THE EVOLUTION OF MODERN MEDICINE

liable to fines for inaccurate copies. The trade must have been exten-
sive in those early days, as Rashdall mentions that in 1323 there were
twenty-eight sworn booksellers in Paris, besides keepers of bookstalls
in the open air.

MEDIEVAL PRACTICE

The Greek doctrine of the four humors colored all the conceptions
\ of disease; upon their harmony alone it was thought that health de-
pended. The four temperaments, sanguine, phlegmatic, bilious and
melancholic, corresponded with the prevalence of these humors. The
body Was composed of certain natural things, seven in number — the
elements, the temperaments, the humors, the members or parts, the
virtues or faculties, the operations or functions and the spirits. Cer-
tain non-natural things preserved the health of the body, six in num-
ber — air, food and drink, movement and repose, sleeping and waking,
excretion and retention, and the passions. Disease was due usually
to alterations in the cornposition of the humors, and the indications
for treatment were in accordance with these doctrines. They were to
be evacuated, tenuated, cooled, heated, purged or strengthened. This
humoral doctrine prevailed throughout the Middle Ages, and reached
far into modern times — indeed, echoes of it are still to be heard in
popular conversations on the nature of disease.

The Arabians were famous for their vigor and resource in matters
of treatment. Bleeding was the first resort in a large ma j ority of all
diseases. In the "Practica" of Ferrari there is scarcely a malady for
which it is not recommended. All remedies were directed to the regu-
lation of the six non-naturals, and they either preserved health, cured
the disease — or did the opposite. The most popular medicines were
derived from the vegetable kingdom, and as they were chiefly those
recommended by Galen, they were, and still are, called by his name.
Many important mineral medicines were introduced by the Arabians,
particularly mercury, antimony, iron, etc. There were in addition
scores of substances, the parts or products of animals, some harmless,
others salutary, others again useless and disgusting. Minor surgery
was in the hands of the barbers, who performed all the minor opera-
tions, such as bleeding ; the more important operations, few in number,
were performed by surgeons.

ASTROLOGY AND DIVINATION 119

ASTROLOGY AND DIVINATION

At this period astrology, which included astronomy, was everywhere
taught. In the "Gouernaunce of Prynces, or Pryvete of Pryveties,"
translated by James Yonge, 1422,'" there occurs the statement: "As
Galian the full wies leche Saith and Isoder the Gode clerk, hit wit-
nessith that a man may not perfitely can the sciens and craft of Medis-
sin but yef he be an astronomoure."

We have seen how the practice of astrology spread from Babylonia
and Greece throughout the Roman Empire. It was carried on into
the Middle Ages as an active and aggressive cult, looked upon askance
at times by the Church, but countenanced by the courts, encouraged at
the universities, and always by the public. In the curriculum of the
mediaeval university, astronomy made up with music, arithmetic and
geometry the Quadrivium. In the early faculties, astronomy and
astrology were not separate, and at Bologna, in the early fourteenth
century, we meet with professors of astrology." One of his duties, as
a salaried professor, was to supply "judgements" gratis for the benefit
of enquiring students, a treacherous and delicate professorship, as
that most distinguished occupant of the chair at Bologna found, Cecco
d'Ascoli, who was burned at the stake in 13.57, a victim of the Floren-
tine Inquisition.^^

Roger Bacon was a warm believer in judicial astrology and in the
influence of the planets, stars and comets on generation, disease and
death.

Many of the stronger minds of the Renaissance broke away from
the follies of the subject. Thus Cornelius Agrippa in reply to the
request of a friar to consult the stars on his behalf says:^" "Judicial
astrology is nothing more than the fallacious guess of superstitious
men, who have founded a science on uncertain things and are deceived
by it : so think nearly all the wise ; as such it is ridiculed by some most
noble philosophers; Christian theologians reject it, and it is con-
demned by sacred councils of the Church. Yet you, whose office it is

20 Early English Text Society, Extra Series, No. LXXIV, p. 195, 1898; Secreta Secretorum,
Rawl. MS. B., 490.

27 Rashdall: Universities of Europe in the Middle Ages, Vol. I, p. 240.

28 Rashdall, 1. c, Vol. I, p. 244. — Rashdall also mentions that in the sixteenth century at
Oxford there is an instance of a scholar admitted to practice astrology. 1. c, Vol. II, p. 458.

29 H. Morley: The Life of Henry Cornelius Agrippa, London, 1856, Vol. II, p. 138.

120 THE EVOLUTION OF MODERN MEDICINE

to dissuade others from these vanities, oppressed, or rather blinded by
I know not what distress of mind, flee to this as to a sacred augur, and
as if there were no God in Israel, that you send to inquire of the god
of Ekron."

But in spite of the opposition of the Church it was tolerated, and
many of the universities at the end of the fifteenth century published

1^205noflico DC atano

CORRENTE DEL NOSTRO SALVA

corf If fu Chrifto. 1 54(;.Compollo t calcuUro al

MfTi'dfano dftlincli'ta Citra di Roma ptr

lo Egrtgio Aftrologo .M.Bfntdttto

FfirariodaCenio.

FIG. 50.
Astrological Prognostication of IS-iG.

almanacs, which were known as "Prognosticons," and the practice
was continued far into the sixteenth century. I show you here an
illustration. (Fig. 50.) Rabelais, you may remember, when physi-
cian to the Hotel Dieu in Lyons, published almanacs for the years
1533, 1535, 1541, 1546. In the title-page he called himself "Doctor of
Medicine and Professor of Astrology," and they continued to be
printed under his name until 1556. In the preparation of these he

ASTROLOGY AND DIVINATION

121

.iSdi.'

Quanquam

FIG. 51.
Horoscope of Jerome Cardan.

must have had his tongue in his
cheek, as in his famous "Panta-
grueline Prognostication," in
which, to satisfy the curiosity of
all good companions, he had
turned over all the archives of the
heavens, calculated the quadra-
tures of the moon, hooked out all
that has ever been thought by all
the Astrophils, Hypernephilists,
Anemophylakes, Uranopets and
Ombrophori, and felt on every
point with Empedocles.^"

Even physicians of the most
distinguished reputation prac-
tised judicial astrology. Jerome
Cardan was not above earning money by casting horoscopes, and on
this subject he wrote one of his most popular books (De Supplemento
Almanach, etc., 1543), in which astronomy and astrology are mixed
in the truly medigeval fashion. He gives in it some forty-seven nativi-
ties, remarkable for the events they foretell, with an exposition. One
of the accusations brought against him was that he had "attempted to
subject to the stars the Lord of the stars and cast our Saviour's horo-
scope."^^ Cardan professed to have abandoned a practice looked upon
with disfavor both by the Church and bjr the universities, but he
returned to it again and again. I show here his own horoscope (Fig.
51). That remarkable character, Michael Servetus, the discoverer of
the lesser circulation, when a fellow student with Vesalius at Paris,
gave lectures upon judicial astrology, which brought him into conflict
with the faculty; and the rarest of the Servetus works, rarer even
than the "Christianismi Restitutio," is the "Apologetica disceptatio
pro astrologia," one copy of which is in the Bibliotheque Na-
tionale. Nor could the new astronomy and the acceptance of the
heliocentric views dislocate the popular belief. The literature of the
seventeenth century is rich in astrological treatises dealing with
medicine.

30 Pantagrueline Prognostication, Rabelais, W. F. Smith's translation, 1893, Vol. II, p. 460.

31 De Thou, Lib. LXII, quoted by Morley in Life of Jerome Cardan, Vol. II, p. 394.

122 THE EVOLUTION OF MODERN MEDICINE

No one has ever poured such satire upon the mantie arts as did
Rabelais in chapter twenty-five of the third book of "Pantagruel."
Panurge goes to consult Her Trippa — the famous Cornelius Agrippa,
whose opinion of astrology has already been quoted, but who neverthe-
less, as court astrologer to Louise of Savoy, had a great contemporary
reputation. After looking Panurge in the face and making conclu-
sions by metoposcopy and physiognomy, he casts his horoscope secun-
dum artem, then, taking a branch of tamarisk, a favorite tree from
which to get the divining rod, he names some twenty-nine or thirty
mantie arts, from pyromancy to necromancy, by which he offers to
predict his future. While full of rare humor, this chapter throws
an interesting light on the extraordinary number of modes of divina-
tion that have been employed. Small wonder that Panurge repented
of his visit ! I show here the title-page of a popular book by one of the
most famous of the English astrological physicians, Nicholas Cul-
peper. (Fig. 52.)

Never was the opinion of sensible men on this subject better
expressed than by Sir Thomas Browne :^^ "Nor do we hereby reject or
condemn a sober and regulated Astrology; we hold there is more truth
therein than in Astrologers; in some rnore than many allow, yet in
none so miich as some pretend. We deny not the influence of the
Starres, but often suspect the due application thereof; for though we
should affirm that all things were in all things ; that Heaven were but
Earth Celestified, and earth but Heaven terrestrified, or that each part
above had an influence upon its divided affinity below; yet how to
single out these relations, and duly to apply their actions, is a work
ofttimes to be effected hj some revelation, and Cabala from above,
rather than any Philosophy, or speculation here below."

As late as 1699, a thesis was discussed at the Paris Faculty,
"Whether comets were harbingers of disease," and in 1707 the Faculty
negatived the question propounded in a thesis, "Whether the moon had
any sway on the human body."

The eighteenth and nineteenth centuries saw, among intelligent
men, a progressive weakening of the belief in the subject; but not even
the satire of Swift, with his practical joke in predicting and announc-
ing the death of the famous almanac maker, nor contemptuous neglect

32 Sir Thomas Browne: Pseudodoxia Epidemica, Bk. IV, Chap. XIII. (Wilkin's ed., Vol.
Ill, p. 84.)

ASTROLOGY AND DIVINATION

123

f

Semeiotica Z^ntnica ;
OR, AN

ASTROLOGICAL

JUDGEMENT

D I S E°A S E S

From the Decimibiturc of the lick

much Enlarged.
I .Frovi Aven Ezra h)i way oflntrothtction.
J.Fraz»NotIDuret/7 nay of Direction.

wherein is laid down.

The way and manner of finding out the

Caufe, Change , and Ead of thedifcifc. Alfo

whether the fick be likely to live or die ; and thetimo

whcn Recovery or Death is to be expciieJ.

/ith the Signs of Life or Death bythchajy of the Sick'

party, according to the judgment of H:ppKraKs.

Wh^remu U ajdtd,

\ Table of Logifticall Logarithmes , to find the cxaft

iiax(ithcCv\fii, Heiir.csthfmigiflm upon thefirrt De-

cumbimre of tjicflck: (hewing the figns & conicfturc-s

of the direafe,and of life and death,by the good or eril

pofition of the Moon at the time of the PaVients lying

down, or demanding thequenion : rnfallible figns m

Jtnow of whit complexion any perfon is whatfocver :

With a compendious Treatifc of Urine.

i5>NlCHOL AS CutPEPERGewr.
Student bi fkyfick^and A'irologie.

- Difci,fei irn^adat na/i, rui^afaqui fan«,f. IV-rfius.

London, Printed for Natk. Brookes ac tiie Gol-
den Angel on CsrnWl, n?er the Exchiir.gr, i'>t8.

FIG. 52.
Title-page of astrological treatise by Nicholas Culpeper (1658).

of the subject of late years sufficed to dispel the belief from the minds
of the public. Garth in the Dispensary (1699) satirizes the astro-
logical practitioners of his day :

The Sage in Velvet Chair, here lolls at Ease

To promise future Health for present Fees

Then as from Tripod solemn Sham reveals

And what the Stars know nothing of foretels. (Canto ii.)

The almanacs of Moore and Zadldel continue to be published, and
remain popular. In London, sandwich men are to be met with carry-

124 THE EVOLUTION OF MODERN MEDICINE

ing advertisements of Chaldeans and Egyptians who offer to tell your
fortune by the stars. Even in this country, astrology is still practised
to a surprising extent if one may judge from advertisements in certain
papers, and from publications which must have a considerable sale.
Many years ago, I had as a patient an estimable astrologer, whose
lucrative income was derived from giving people astral information as
to the rise and fall of stocks. It is a chapter in the vagaries of the
human mind that is worth careful study.^'' Let me commend to your
reading the sympathetic story called "A Doctor of Medicine" in the
"Rewards and Fairies" of Kipling. The hero is Nicholas Culpeper,
Gent., whose picture is here given. One stanza of the poem at the
end of the story, "Our Fathers of Old," may be quoted:

Wonderful tales had our fathers of old —

Wonderful tales of the herbs and the stars —
The Sun was Lord of the Marigold,

Basil and Rocket belonged to Mars.
Pat as a sum in division it goes — ■

(Every plant had a star bespoke) —
Who but Venus should govern the Rose ?

Who but Jupiter own the Oak?

Simply and gravely the facts are told

In the wonderful books of our fathers of old.

James J. Walsh of New York has written a book of extraordinary
interest called "The Thirteenth, Greatest of Centuries." I have not
the necessary knowledge to say whether he has made out his case or
not for art and for literature. There was certainly a great awaken-
ing and, inspired by high ideals, men turned with a true instinct to
the belief that there was more in life than could be got out of barren
scholastic studies. With many of the strong men of the period one
feels the keenest mental sympathy. Grosseteste, the great Clerk of
Lincoln, as a scholar, a teacher and a reformer, represents a type of
mind that could grow only in fruitful soil. Roger Bacon may be
called the first of the moderns — certainly the first to appreciate the

33 It is not generally known that Stonewall Jackson practised astrology. Col. J. W. Revere
in "Keel and Saddle" (Boston, 1873) tells of meeting Jackson in 1853 on a Mississippi steamer
and talking with him on the subject. Some months later, Revere received a letter from
Jackson enclosing his (Revere's) horoscope. There was a "culmination of the malign aspect
during the first days of May, 1863 — ^both will be exposed to a common danger at the time
indicated." At the battle of Chancellorsville, May 3, 1863, Revere saw Jackson mortally
wounded !

ASTROLOGY AND DIVINATION 125

extraordinary possibilities which lay in a free and untrammelled study X
of nature. A century which could produce men capable of building
the Gothic cathedrals may well be called one of the great epochs in
history, and the age that produced Dante is a golden one in literature.
Humanity has been the richer for St. Francis ; and Abelard, Albertus
and Aquinas form a trio not easy to match, in their special depart-
ments, either before or after. But in science, and particularly in
medicine, and in the advance of an outlook upon nature, the thirteenth
century did not help man very much. Roger Bacon was "a voice
crying in the wilderness," and not one of the men I have picked out
as specially typical of the period instituted any new departure either in
practice or in science. They were servile followers, when not of the L^
Greeks, of the Arabians. This is attested by the barrenness of the
century and a half that followed. One would have thought that the
stimulus given by JNIundinus to the study of anatomy would have
borne fruit, but little was done in science during the two and a half
centuries that followed the delivery of his lectures and still less in the
art. While William of Wykeham was building Winchester Cathedral
and Chaucer was writing the Canterbury Tales, John of Gaddesden
in practice was blindly following blind leaders whose authority no one
dared question.

The truth is, from the modern standpoint the thirteenth was not the ^
true dawn brightening more and more unto the perfect day, but a i
glorious aurora which flickered down again into the arctic night of \
mediaevalism.

To sum up — in medicine the Middle Ages represent a restatement
from century to century of the facts and theories of the Greeks
modified here and there by Arabian practice. There was, in Francis
Bacon's phrase, much iteration, small addition. The schools bowed
in humble, slavish submission to Galen and Hippocrates, taking
everything from them but their spirit and there was no advance in our
knowledge of the structure or function of the body. The Arabians
lit a brilliant torch from Grecian lamps and from the eighth to the
eleventh centuries the profession reached among them a position of
dignity and importance to which it is hard to find a parallel in history.

CHAPTER IV

THE RENAISSANCE AND THE RISE OF
ANATOMY AND PHYSIOLOGY

THE "reconquest of the classic world of thought was by far the
most important achievement of the fifteenth and sixteenth
centuries. It absorbed nearly the whole mental energy of the
Italians. . . . The revelation of what men were and what they wrought
under the influence of other faiths and other impulses, in distant ages
with a different ideal for their aim, not onljj^ widened the narrow
horizon of the Middle Ages, but it also restored self-confidence to
the reason of humanity."^

Everywhere throughout the Middle Ages learning was the hand-
maid of theology. Even Roger Bacon with his strong appeal for a
new method accepted the dominant mediaeval conviction — that all the
sciences did but ifiinister to their queen, Theology. A new spirit
entered man's heart as he came to look upon learning as a guide to
the conduct of life. A revolution was slowly effected in the intellec-
tual world. It is a mistake to think of the Renaissance as a brief
period of sudden fruitfulness in the North Italian cities. So far as
science is concerned, the thirteenth century was an aurora followed by
a long period of darkness, but the fifteenth was a true dawn that
brightened more and more unto the perfect day. Always a reflex of
its period, medicine joined heartily though slowly in the revolt against
mediasvalism. How slowly I did not appreciate until recently.
Studying the earliest printed medical works to catch the point of view
of the men who were in the thick of the movement up to 1480 — ^which
may be taken to include the first quarter of a century of printing —
one gets a startling record. The mediaeval mind still dominates:
of the sixty-seven authors of one hundred eighty-two editions of early
medical books, twenty-three were men of the thirteenth and four-

1 J. A. Symonds: The Renaissance in Italy; the Revival of Learning, 1877, p. 52.

RISE OF ANATOMY AND PHYSIOLOGY 127

teenth centuries, thirty men of the fifteenth century, eight wrote in
Arabic, several were of the School of Salernum, and only six were of
classical antiquity, uiz., Pliny (first 1469), Hippocrates (1473) [Hain
*7247], Galen (1475) [Hain 7237], Aristotle (1476), Celsus (1478),
and Dioscorides (1478).t

The medical profession gradually caught the new spirit. It has
been well said that Greece arose from the dead with the New Testa-
ment in the one hand and Aristotle in the other. There was awakened
a perfect passion for the old Greek writers, and with it a study of the
original sources, which had now become available in many manu-
scripts. Gradually Hippocrates and Galen came to their own again.
Almost every professor of medicine became a student of the MSS. of
Aristotle and of the Greek physicians, and before 1530 the presses
had poured out a stream of editions. A wave of enthusiasm swept
over the profession, and the best energies of its best minds were
devoted to a study of the Fathers. Galen became the idol of the
schools. A strong revulsion of feeling arose against the Arabians, and
Avicenna, the Prince, who had been clothed with an authority only a
little less than divine, became anathema. Under the leadership of the
Montpellier School, the Arabians made a strong fight, but it was a
losing battle all along the line. This group of medical humanists —
men who were devoted to the study of the old humanities, as Ijatin
and Greek were called — ^has had a great and beneficial influence upon
the profession. They were for the most part cultivated gentlemen
with a triple interest — literature, medicine and natural history. How
important is the part they played may be gathered from a glance at
the "Lives" given by Bayle in his "Biographic Medicale" (Paris,
1855) between the years 1500 and 1575. More than one half of them
had translated or edited works of Hippocrates or Galen; many of
them had made important contributions to general literature, and a
large proportion of them were naturalists: Leonicenus, Linacre,
Champier, Fernel, Fracastorius, Gonthier, Caius, J. Sylvius, Brasa-
vola, Fuchsius, Matthiolus, Conrad Gesner, to mention only those I

* This asterisk is used by Hain to indicate that he had seen a copy.^ — Ed.

t Data added to manuscript taken from author's summary on "Printed Medical Books to
1480" in Transactions of the Bibliographical Society, London, 1916, XIII, S-8, revised from its
"News-Sheet" (February, 1914). "Of neither Hippocrates nor Galen is there an early edition;
but in 1473 at Pavia appeared an exposition of the Aphorisms of Hippocrates, and in 1475 at
Padua an edition of the Tegni or Notes of Galen." Ibid., p. 6. Osier's unfinished Illustrated
Monograph on this subject is now being printed for the Society of which he was President.
—Ed.

128 THE EVOLUTION OF MODERN MEDICINE

know best, form a great group. Linacre edited Greek works for
Aldus, translated works of Galen, taught Greek at Oxford, wrote
Latin grammars and founded the Roj^al College of Physicians.* Caius
was a keen Greek scholar, an ardent student of natvu-al history, and his

FIG. 53.
Thomas Linacre.

name is enshrined as co-founder of one of the most important of the
Cambridge colleges. Gonthier, Fernel, Fuchs and Mattioli were
great scholars and greater physicians. Champier, one of the most
remarkable of the group, was the founder of the Hotel Dieu at Lyons,
and author of books of a characteristic Renaissance type and of sin-

* Cf . Osier: Thomas Linacre, Cambridge University Press, 1908. — Ed.

FIG. 54.
John Caius.

|>S»*..

FIG. 55.
Conrad Gesner.

RISE OF ANATOMY AND PHYSIOLOGY 131

gular bibliographical interest. In many ways greatest of all was
Conrad Gesner, whose mors inopinata at forty-nine, bravely fighting
the plague, is so touchingly and tenderly mourned by his friend Caius.^
Physician, botanist, mineralogist, geologist, chemist, the first great
modern bibliographer, he is the very embodiment of the spirit of the
age.^* In thfe flyleaf of my copy of the "Bibliotheca Universalis"
(1545), is written a fine tribute to his memory. I do not know by
whom it is, but I do know from my reading that it is true :

".Conrad Gesner, who kept open house there for all learned men
who came into his neighborhood. Gesner was not only the best
naturalist among the scholars of his day, but of all men of that century
he was the pattern man of letters. He was faultless in private life,
assiduous in study, diligent in maintaining correspondence and good-
will with learned men in all countries, hospitable— ^though his means
were small — ^to every scholar that came into Ziirich. Prompt to serve
all, he was an editor of other men's volumes, a writer of prefaces for
friends, a suggestor to young writers of books on which they might
engage themselves, and a great helper to them in the progress of their
work. But still, while finding time for services to other men, he could
produce as much out of his own study as though he had no part in the
life beyond its walls."

A large majority of these early naturalists and botanists were
physicians.' The Greek art of observation was revived in a study of
the scientific writings of Aristotle, Theophrastus a,nd Dioscorides and
in the original MSS. of Hippocrates and of Galen. That progress
was at first slow was due in part to the fact that the leaders were too
busy scraping the Arabian tarnish from the pure gold of Greek
medicine and correcting the anatomical mistakes of Galen to bother
much about his physiology or pathology. Here and there among the
great anatomists of the period we read of an experiment, but it was
the art of observation, the art of Hippocrates, not the science of
Galen, not the carefully devised experiment to determine function,
that characterized their work. There was indeed every reason why
men should have been content with the physiology and pathology of
that day, as, from a theoretical standpoint, it was excellent. The

2 Joannis Caii Britanni de libris suis, etc., 1570.

2a See J. C. Bay: Papers Bibliog. Soc. of America, 1916, X, No. 2, 53-86.

3 Miall: The Early Naturalists, London, 1912.

132 THE EVOLUTION OF MODERN MEDICINE

doctrine of the. four humors and of the natural, animal and vital
spirits afforded a ready explanation for the symptoms of all diseases,
and the practice of the day was admirably adapted to the theories.
There was no thought of, no desire for, change. But the revival of
learning awakened in men at first a suspicion and at last a conviction
that the ancients had left something which could be reached by inde-
pendent research, and gradually the paralytic-like torpor passed
away.

The sixteenth and seventeenth centuries did three things in medi-
cine-^shattered authority, laid the foundation of an accurate knowl-
edge of the structure of the human body^and demonstrated how its
functions should be studied intelligently — ^with which advances, as
illustrating this period, may be associated the names of Paracelsus,
Vesalius and Harvey.

PARACELSUS

Paracelsus is "der Geist der stets verneint." He roused men against
the dogmatism of the schools, and he stimulated enormously the prac-
^tical study of chemistry. These are his great merits, against which
must be placed a flood of hermetical and transcendental medicine,
some his own, some foisted in his name, the influence of which is still
with us.

"With what judgment ye judge it shall be judged to you again"
is the verdict of three centuries on Paracelsus. In return for un-
measured abuse of his predecessors and contemporaries he has been
held up to obloquy as the arch-charlatan of history. We have taken
a cheap estimate of him from Fuller and Bacon, and from a host of
scurrilous scribblers who debased or perverted his writings. Fuller*
picked him out as exemplifying the drunken quack, whose body was a
sea wherein the tide of drunkenness was ever ebbing and flowing —
"He boasted that shortly he would order Luther and the Pope, as well
as he had done Galen and Hippocrates. He was never seen to pray,
and seldome came to Church. He was not onely skilled in naturall
Magick (the utmost bounds whereof border on the suburbs of hell)
but is charged to converse constantly with familiars. Guilty he was
of all vices but wantonnesse : ..."

■i Fuller: The Holy and Profane State, Cambridge, 1642, p. 56.

y^TfS

FIG. 56.
Paracelsus.

134 THE EVOLUTION OF MODERN MEDICINE

Bacon, too, says many hard things of him."

On the other hand, to the mystics he is Paracelsus the Great, the
divine, the most supreme of the Christian magi, whose writings are
too precious for science, the monarch of secrets, who has discovered
the Universal Medicine.

This is illustrated in Browning's well-known poem "Paracelsus,"
published when he was only twenty-one ; and there is no more pleasant
picture in literature of the man and of his aspirations. His was a
"searching and impetuous soul" that sought to win from nature some
startling secret — " ... a tincture of force to flush old age with youth,
or breed gold, or imprison moonbeams till they change to opal
shafts !" At the same time with that capacity for self-deception which
characterizes the true mystic he sought to cast

Light on a darkling race ; save for that doubt,
I stood at first where all aspire at last
To stand : the secret of the world was mine.
I knew, I felt (perception unexpressed,
Uncomprehended by our narrow thought,
But somehow felt and known in every shift
And change in the spirit, — nay, in every pore
Of the body, even) — what God is, what we are,
What life is— . . :"

Much has been done of late to clear up his story and his character.
Professor Sudhoff, of Leipzig, has made an exhaustive bibliographi-
cal study of his writings,' there have been recent monographs by
Julius Hartmann, and Professors Franz and Karl Strunz,* and a
sympathetic summary of his life and writings has been published by
the late Miss Stoddart." Indeed there is at present a cult of Para-
celsus. The hermetic and alchemical writings are available in English
in the edition of A. E. Waite, London, 1894. The main facts of his
life you can find in all the biographies. Suffice it here to say that he

5 Bacon: Of the Proflcience and Advancement of Learning, Bk. II, Pickering ed., London,
184fl, p. 181. Works, Spedding ed., Ill, 381.

8 Robert Browning: Paracelsus, closing speech.

7 Professor Sudhoff: Bibliographia Paracelsica, Berlin, 1894, 1899.

sR. Julius Hartmann: Theophrast von Hohenheim, Berlin, 1904; ditto, Franz Strunz,
Leipzig, 1903.

9 Anna M. Stoddart: The Life of Paracelsus, London, John Murray, 1911.

PARACELSUS 135

was born at Einsiedeln, near Zurich, in 1493, the son of a physician, V
from whom he appears to; have had his early training both in medicine
and in chemistry. Under the famous abbot and alchemist, Trithemius
of Wiirzburg, he studied cherhistry and occultism. After working in
the mines at Schwatz he began his wanderings, during which he
professes to have visited nearly all the countries in Europe and to
have reached India and China. Returning to Germany he began a
triumphal tour of practice through the German cities, always in
opposition to- the medical faculty, and constantly in trouble. He
undoubtedly performed many important cures, and was thought to
have found the supreme secret of alchemistry. In the pommel of his
sword he was believed to carry a familiar spirit. So dominant was
his reputation that in 1527 he was called to the chair of physic in the
University of Basel. Embroiled in quarrels after his first year he
was forced to leave secretly, and again began his wanderings through
German cities, working, quarrelling, curing, and dying prematurely
at Saltzburg in 1541 — one of the most tragic figures in the history of
medicine.

Paracelsus is the Luther of medicine, the very incarnation of the "V
spirit of revolt. At a period when authority was paramount, and men
blindly followed old leaders, when to stray from the beaten track in
any field of knowledge was a damnable heresy, he stood out boldly
for independent study and the right of private judgment. After
election to the chair at Basel he at once introduced a startling novelty
by lecturing in German. He had caught the new spirit and was
ready to burst all bonds both in medicine and in theology. He must
have startled the old teachers and practitioners by his novel methods.
"On June 5, 1527, he attached a programme of his lectures to the
black-board of the University inviting all to come to them. It began
by greeting all students of the art of healing. He proclaimed its lofty
and serious nature, a gift of God to man, and the need of developing
it to new importance and to new renown. This he undertook to do,
not retrogressing to the teaching of the ancients, but progressing
whither nature pointed, through research into nature, where he himself
had discovered and had verified by prolonged experiment and experi-
ence. He was ready to oppose obedience to old lights as if they were
oracles from which one did not dare to differ. Illustrious doctors
might be graduated from books, but books made not a single physi-

136 THE EVOLUTION OF MODERN MEDICINE

cian.^° Neither graduation, nor fluency, nor the knowledge of old
languages, nor the reading of many books made a physician, but the
knowledge of things themselves and their properties. The business
of a doctor was to know the different kinds of sicknesses, their causes,
their symptoms and their right remedies. This he would teach, for he

:ic^ ' ff-^--

' tto/b#/6t>ii8ro(^/OT>iitoiiTOiK tt«i i» >iBM >li«8igfit'

nxmsatfitunflMBttonAUmQtbicfMTim

gqtygt'l?on&ct: Altmimbnanwneirif

(Ion ctfit^n^nit^ vttf

»igfqr«b/mwjfit«ttffti"3ej»«n»««fn/iiritf«Iipt«lto;

tKttigjdr,

1Ptt^iat/wt>imMffiwmfcb«tm>ti;wwi'|rc X gqit))fct/t«;m'
ha«/idUanli<aIiuilt</«nl>nalK>Sl<>4aM'««i^«oW<»a>

FIG. 57.
Title-page of Paracelsus' Treatise on Surgery (1536).

had won this knowledge through experience, the greatest teacher, and
with much toil. He would teach it as he had learned it, and his lectures
would be founded on works which he had composed concerning inward
and external treatment, physic and surgery."" Shortly afterwards,

10 And men have oft grown old among their books

To die case hardened in their ignorance. — Paracelsus, Browning.

11 Anna M. Stoddart: Life of Paracelsus, London, 1911, pp. 95-96.

PARACELSUS 137

at the Feast of St. John, the students had a bonfire in front of the
university. Paracelsus came out holding in his hands the "Bible of
medicine," Avicenna's "Canon," which he flung into the flames
saying: "Into St. John's fire so that all misfortune may go into
the air with the smoke." It was, as he explained afterwards, a
symbolic act; "What has perished must go to the fire; it is no longer
fit for use: what is true and living, that the fire cannot burn." With
abundant confidence in his own capacity he proclaimed himself the
legitimate monarch, the very Christ of medicine. "You shall follow
me," cried he, "you, Avicenna, Galen, Rhasis, Montagnana, Mesues;
you, Gentlemen of Paris, Montpellier, Germany, Cologne, Vienna,
and whomsoever the Rhine and Danube nourish; you who inhabit
the isles of the sea ; you, likewise, Dalmatians, Athenians ; thou, Arab ;
thou, Greek; thou, Jew; all shall follow me, and the monarchy shall
be mine."^^

This first great revolt against the slavish authority of the schools
had little immediate effect, largely on account of the personal vagaries
of the reformer — but it made men think. Paracelsus stirred the pool
as had not been done for fifteen centuries.

Much more important is the relation of Paracelsus to the new
chemical studies, and their relation to practical medicine. Alchemy,
he held, "is to make neither gold nor silver: its use is to make the
supreme sciences and to direct them against disease." He recognized
three basic substances, sulphur, mercury and salt, which were the
necessary ingredients of all bodies organic or inorganic. They were
the basis of the three principles out of which the Archasus, the spirit of
nature, formed all bodies. He made important discoveries in chemis-
try; zinc, the various compounds of mercury, calomel, flowers of
sulphur, among others, and he was a strong advocate of the use of
preparations of iron and antimony. In practical pharmacy he has
perhaps had a greater reputation for the introduction of a tincture of
opium — labdanum or laudanum — with which he effected miraculous
cures, and the use of which he had probablj^ learned in the East.

Through Paracelsus a great stimulus was given to the study of
chemistry and pharmacy, and he is the first of the modern iatro-
chemists.. In contradistinction to Galenic medicines, which ~were
largely derived from the vegetable kingdom, from this time on we find

12 Browning's Paracelsus, London, 1835, p. 206 (note).

138 THE EVOLUTION OF MODERN MEDICINE

V in the literature references to spagyric medicines and a "spagyrist"
^ was a Paracelsian who regarded chemistry as the basis of all medical
knowledge.

One cannot speak very warmly of the practical medical writings of
Paracelsus. Gout, which may be taken as the disease upon which he
had the greatest reputation, is very badly described, and yet he has
one or two fruitful ideas singularly mixed with mediaeval astrology;
but he has here and there very happy insights, as where he remarks
"nee prceter synoviam locum, alium allum podagra occupat."^^ In
the tract on phlebotomy I see nothing modern, and here again he is
everywhere dominated by astrological ideas — "Sapiens dominatur
astris."

As a protagonist of occult philosophy, Paracelsus has had a more
enduring reputation than as a physician. In estimating his position
there is the great difficulty referred to by Sudhoff in determining
which of the extant treatises are genuine. In the two volumes issued
in English by Waite in 1894, there is much that is difficult to read and
to appreciate from our modern standpoint. In the book "Concerning
Long Life" he confesses that his method and practice will not be
intelligible to common persons and that he writes only for those whose
intelligence is above the average. To those fond of transcendental
studies they appeal and are perhaps intelligible. Everywhere one
comes across shrewd remarks which prove that Paracelsus had a keen
belief in the all-controlling powers of nature and of man's capacity
\io make those powers operate for his own good: "the wise man rules
Nature, not Nature the wise man." "The difference between the
Saint and the Magus is that the one operates hy means of God, and the
other by means of Nature." He had great faith in nature and the
light of nature, holding that man obtains from nature according as he
believes. His theory of the three principles appears to have controlled
his concepition of everything relating to man, spiritually, mentally and
bodily; and his threefold genera of disease corresponded in some
A mysterious way with the three primary substances, salt, sulphur and
mercury.

How far he was ia believer in astrology, charms and divination it is
not easy to say. From many of the writings in his collected works
one would gather, as I have already quoted, that he was a strong

13 Geneva ed., 1658, Vol. I, p. 613. .

PARACELSUS

139

believer. On the other hand, in the "Paramirum," he says: "Stars
control nothing in us, suggest nothing, incline to nothing, own
nothing; they are free from us and we are free from them" (Stod-

rRcnw/me

Mcrode

FIG. 58.

Portrait and lineage of Van Helmont.

{Opposite p. 1 of his Ortus Medicince, Ehevir edition, 1648.)

dart, p. 185), The Archseus, not the stars, controls man's destiny.
"Good fortune comes from ability, and ability comes from the spirit"
(Archjeus).

140 THE EVOLUTION OF MODERN MEDICINE

No one has held more firmly the dualistic conception of the healing
art. There are two kinds of doctors; those who heal miraculously
and those who heal through medicine. Only he who believes can work
miracles. The physician has to accomplish that which God would
have done miraculously, had there been faith enough in the sick man
(Stoddart, p. 194). He had the Hippocratic conception of the "vis
medicatrix naturce" — no one keener since the days of the Greeks.
Man is his own doctor and finds proper healing herbs in his own
garden : the physician is in ourselves, in our own nature are all things
that we need: and speaking of wounds, with singular prescience he
says that the treatment should be defensive so that no contingency
from without could hinder Nature in her work (Stoddart, p. 213).

Paracelsus expresses the healing powers of nature by the word
"mumia," which he regarded as a sort of magnetic influence or force,
and he believed that anyone possessing this could arrest or heal disease
in others. As the lily breaks forth in invisible perfume, so healing
influences may pass from an invisible body. Upon these views of
Paracelsus was based the theory of the sympathetic cure of disease
/which had an extraordinary vogue in the late sixteenth and seven-
teenth centuries, and which is not without its modern counterpart.

In the next century, in Van Helmont we meet with the Archaeus
everywhere presiding, controlling and regulating the animate and
inanimate bodies, working this time through agents, local ferments.
The Rosicrucians had their direct inspiration from his writings, and
such mystics as the English Rosicrucian Fludd were strong Para-
celsians.^*

The doctrine of contraries drawn from the old Greek philosophy,
upon which a good deal of the treatment of Hippocrates and Galen
was based — dryness expelled by moisture, cold by heat, etc. — ^was
opposed by Paracelsus in favor of a theory of similars, upon which
the practice of homeopathy is based. This really arose from the
primitive beliefs, to which I have already referred as leading to the
use of eyebright in diseases of the eye, and cyclamen in diseases of the
ear because of its resemblance to that part ; and the Egyptian organo-
therapy had the same basis, — spleen would cure spleen, heart, heart,
etc. In the sixteenth and seventeenth centuries these doctrines of

^t Robert Fludd, the Mystical Physician, British Medical Journal, London, 1897, li, 408.

^PARACELSUS 141

sympathies and antipathies were much in vogue. A Scotchman,
Sylvester Rattray, edited in the "Theatrum Sympatheticum"^' all the
writings upon the sympathies and antipathies of man with animal,
vegetable and mineral substances, and the whole art of physics was
based on this principle.

Upon this theory of "mumia" or magnetic force, the sympathetic
cure of disease was based. The weapon salve, the sympathetic oint-
ment, and the famous powder of sympathy were the instruments y(
through which it acted. The magnetic cure of wounds became the
vogue. Van Helmont adopted these views in his famous treatise "De
Magnetica Vulnerum Curatione,"^" in which he asserted that cures
were wrought through magnetic influence. How close they came to
modern views of wound infection may be judged from the following:
"Upon the solution of Unity in any part the ambient air . . . repleted
with various evaporations or aporrhoeas of mixt bodies, especially such
as are then suffering the act of putrefaction, violently invadeth the
part and thereupon impresseth an exotic miasm or noxious diathesis,
which disposeth the blood successively arriving at the wound, to putre-
faction, by the intervention of fermentation." With his magnetic
sympathy. Van Helmont expressed clearly the doctrine of immunity
and the cure of disease by immune sera: "For he who has once recov-
ered from that disease hath not only obtained a pure balsaamical blood,
whereby for the future he is rendered free from any recidivation of the
same evil, but also infallibly cures the same affection in his neighbour
. . . and by the mysterious power of Magnetism transplants that
balsaam and conserving quality into the blood of another." He was
rash enough to go further and say that the cures effected by the relics
of the saints were also due to the same cause — a statement which led to
a great discussion with the theologians and to Van Helmont's arrest
for heresy, and small wonder, when he makes such bold statements
as "Let the Divine enquire only concerning God, the Naturalist con-
cerning Nature," and "God in the production of miracles does for the
most part walk hand in hand with Nature."

That wandering genius, Sir Kenelm Digby, did much to popularize
this method of treatment by his lecture on the "Powder of Sym-

15 Rattray: Theatrum Sympatheticum, Norinibergae, MDCLXII.

18 An English translation by Walter Charleton appeared in 1650, entitled "A Ternary of
Paradoxes."

142 THE EVOLUTION OF MODERN MEDICINE

pathy."" (Fig. 59.) His powder was composed of copperas alone
or mixed with gum tragacanth. He regarded the cure as effected
through the subtle influence of the sympathetic spirits or, as Highmore
says, by "atomicall energy wrought at a distance," and the remedy
could be applied to the wound itself, or to a cloth soaked in the blood
or secretions, or to the weapon that caused the wound. One factor
leading to success may have been that in the directions which Digby
gave for treating the wound (in the celebrated case of James Howell,
for instance), it was to be let alone and kept clean. The practice is
alluded to very frequently by the poets. In the "Lay of the Last
Minstrel" we find the following:

But she has ta'en the broken lance,
And wash'd it from the clotted gore,
And salved the splinter o'er and o'er.
William of Deloraine, in trance.
Whene'er she turn'd it round and round,
Twisted, as if she gall'd his wound,
Then to her maidens she did say.
That he should be whole man and sound,

(Canto iii, xxiii.)

and in Dryden's "Tempest" (V, 1) Ariel says:

Anoint the sword which pierced him with this
Weapon salve, and wrap it close from air till
I have time to visit him again.

From Van Helmont comes the famous story of the new nose that
dropped off in sympathy with the dead arm from which it was taken,
and the source of the famous lines of Hudibras. As I have not seen
the original story quoted of late years it may be worth while to give it :
"A certain inhabitant of Bruxels, in a combat had his nose mowed off,
addressed himself to Tagliacozzus, a famous Chirurgein, living at
Bononia, that he might procure a new one ; and when he feared the
incision of his own arm, he hired a Porter to admit it, out of whose arm,

17 French edition, 16.58, English translation, same year. For a discussion on the author of
the weapon salve see Van Helmont, who gives the various formulas. Highmore (1651) says
the "powder is a Zaphyrian salt calcined by a celestial fire operating in Leo and Cancer into
a Lunar complexion."

PARACELSUS

143

having first given the reward agreed upon, at length he dig'd a new
About -thirteen moneths after his return to his own Countrey,

nose.

on a sudden the ingrafted nose grew cold, putrified, and within few
days dropt oflp. To those of his friends that were curious in the explo-
ration of the cause of this unexpected misfortune, it was discovered,
that the Porter expired, neer about the same punctilio of time, wherein

I

A LATE

DISCOURSE

Madcin aSolemne Affembly
of Nobles and Learned
Men at S^ontbellier
in France;

By Sr. Kemlme Digbj, Knigat,&c.

Toudiing the Cure of W o u n r. s

by tne Powder ofSfmfAthy-y With

Iiiftiuftions how to make the

faid Powdery whereby many

other Secrets of Nature

are unfolded^

fxlix qui ptuit Reriim cognofcere
can fas.

Rendred faithfully out of French
into Englift

By K. White. Gent.

London, Printfedfor K. Lownes^ and
T Davie', and are to be fold at thtir (hops in
Sr.Pauls Church yai d, at the fign of the White

lMf,andac the BrWe over againft the little
North Door of St. Pauls. Church. i6j8.

FIG. 59.
Title-page of Digby's Powder of Sympathy (1658).

144 THE EVOLUTION OF MODERN MEDICINE

the nose grew frigid and cadaverous. There are at Bruxels yet sur-
viving, some of good repute, that were eye-witnesses of these occur-

J318

rences.

FIG. 60.
Nicolaus Copernicus.

Equally in the history of science and of medicine, 1542 is a starred
year, marked by a revolution in our knowledge alike of Macrocosm
and Microcosm. In Frauenburg, the town physician and a canon, now

isCharleton: Of the Magnetic Cure of Wounds, London, lC50j p. 13.

PARACELSUS 145

Hearing the Psalmist limit and his end, had sent to the press the studies
of a lifetime — "De revolutionibus orbium coelestium." It was no new
thought, no new demonstration that Copernicus thus gave to his
generation. Centuries before, men of the keenest scientific minds
from Pythagoras on had worked out a heliocentric theory, fully pro-
mulgated by Aristarchus, and very generally accepted by the brilliant
investigators of the Alexandrian school; but in the long interval,
lapped in Oriental lethargy, man had been content to acknowledge
that the heavens declare the glory of God and that the firmament
sheweth his handiwork. There had been great astronomers before
Copernicus, and in the fifteenth century Cusa and Regiomontanus
had suggested the heliocentric theory; but 1542 marks an epoch in the
history of science, since for all time Copernicus put the problem in a
way that compelled acquiescence.

Nor did Copernicus announce a truth perfect and complete, not
to be modified, but there were many contradictions and lacunae which
the work of subsequent observers had to reconcile and fill up. For
long years Copernicus had brooded over the great thoughts which his
careful observation had compelled. We can imagine the touching
scene in the little town when his friend Osiander brought the first
copy of the precious volume hot from the press, a well enough printed
book. Already on his deathbed, stricken with a long illness, the old
man must have had doubts how his work would be received, though
years before Pope Clement VII had sent him encouraging words.
Fortunately death saved him from the "rending" which is the portion
of so many innovators and discoverers. His great contemporary
reformer, Luther, expressed the view of the day when he said the
fool will turn topsy-turvy the whole art of astronomy ; but the Bible
says that Jesus commanded the Sun to stand still, not the Earth. The
scholarly Melanchthon, himself an astronomer, thought the book so
godless that he recommended its suppression (Dannemann, Grund-
riss ) . The church was too much involved in the Ptolemaic system to
accept any change and it was not until 1822 that the works of Coper-
nicus were removed from the Index.

146 THE EVOLUTION OF MODERN MEDICINE

VE S ALIUS ,

The same year; 1542, saw a very different picture in the far-famed
city of Padua, "nursery of the arts." The centralflgure was a man
not yet in the prime of life, and justly full of its pride, as you may see
from his portrait. (Fig. 61.) Like Aristotle and ■ Hippocrates
cradled and nurtured in an ^sculapian family, Vesalius was from his
Childhood a student of natjure, and was now a wandering scholar, far
from his Belgian home. But in Il^ly he had found what neither Lou-
vain nor Pa,ris could give, frisedom in his studies and golden opportuni-
ties for research in anatomy. What an impression he must have made
on the student body at Padua may be judged from the fact tha,t
shortly after His graduation in December, 1537, at the age of twenty-
four, he was elected to the chair of anatomy and surgery. Two things
favored him — an insatiate desire to see and handle for himself the
parts of the human frame, and a,n opportiinity, such as had never
before been offered to the teacher, to obtain material for the study of
human anatomy. Learned with all the learning of the, Grecians and
oi the Arabians, Vesalius grasped, as no modern before him had done,
the cardinal fact that to know the human machine and its working, it
is necessary ffrst to know its. parts — its fabric.

To appreciate the work of this great man we must go back in a
brief review of the growth of the study of anatomy.

Among the Greeks only the Alexandrians knew human anatomy.
What their knowledge was we know at second hand, but the evidence
is plain that they knew a great deal. Galen's anatomy was first-claSs
and was based on the Alexandrians and on his studies of the ape and
the pig. We have already noted how much superior was his osteology
to that of Mundihus; Between the Alexandrians and the early days
of the School of Salernum we have no record of systematic dissections
of thfe human body." It is even doubtful if these were permitted at
Salernum. Neubufger states that the instructions of Frederick II as
to dissections were merely nominal.

How atrocious was the anatomy of the early Middle Ages may be
gathered from the cuts in the works of Henri de Mondeville. In the
Bodleian Library is a remarkable English anatomical treatise of the

FIG. 61.

Andreas Vesalius.

(Woodcut opposite p. 1 (if the Fabrica, ISJ/S.)

X

148 THE EVOLUTION OF MODERN MEDICINE

fourteenth century, one illustration from which will suffice to show the
ignorance of the author. (Fig. 62.) Mundinus of Bologna (of
whom I have alreadjr spoken), unquestionably the first man in the
Middle Ages to study anatomy from the subject, was under the strong
domination of the Arabians, from whom he appears to have received
a very imperfect Galenic anatomy. From this date we meet with
occasional dissections at various schools, but we have seen that in the
laborate curriculum of the University of Padua in the middle of the
fifteenth century there was no provision for the study of the subject.
Even well into the sixteenth century dissections were not common,
and the old practice was followed of holding a professorial discourse,
while the butcher, or barber surgeon, opened the cavities of the body.
A member of a famous Basel family of physicians, Felix Plater,
has left us in his autobiography^^ details of the dissections he witnessed
at Montpellier between November 14, 1552, and January 10, 1557,
only eleven in number. How difficult it was at that time to get sub-
jects is shown by the risks they ran in "body-snatching" expeditions,
of which he records three.

And now came the real maker of modern anatomy. Andreas
Vesalius had a good start in life. Of a family long associated with the
profession, his father occupied the position of apothecary to Charles
V, whom he accompanied on his journeys and campaigns. Trained at
Louvain, he had, from his earliest youth, an ardent desire to dissect,
and. cut up mice and rats, and even cats and dogs. To Paris, the
strong school of the period, he went in 1533, and studied under two
men of great renown, Jacob Sylvius and Guinterius. Both were
strong Galenists and regarded the Master as an infallible authority.
He had as a fellow prosector, under the latter, the unfortunate Serve-
tus. The story of his troubles and trials in getting bones and subjects
you may read in Roth's "Life.'"" Many interesting biographical
details are also to be found in his own writings. He returned for a

19 There is no work from which we can get a better idea of the life of the sixteenth-century
medical student and of the style of education and of the degree ceremonies, etc.- Cumston
has given an excellent summary of it (Johns Hopkins Hospital Bulletin, 1913, XXIII, 105-113).

20 M. Roth: Andreas Vesalius Bruxellensis, Berlin, 1893. An excellent account of Vesalius
and his contemporaries is given by Jaihes Moores Ball in his superbly printed Andreas
Vesalius, the Reformer of Anatomy, St. Louis, 1910.

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{From Ashmolean Codex No. 399, folio 18 recto, Bodleian Library, Oxford.)

150 THE EVOLUTION OF MODERN MEDICINE

time to Louvain, and here he pubhshed his first book, a commentary
on the "Almansor" of Rhazes, in 1537.

Finding it difficult, either in Paris or Louvain, to pursue his ana-
tomical studies, he decided to go to Italy where, at Venice and Padua,
the opportunites were greater. At Venice, he attended the practice
of a hospital (now a barracks) which was in-charge of the Theatiner

1^

I I * I

M

FIG. 63.
Hospital frequented by Vesalius at Venice.

Order. I show you a photograph of the building taken last year.
(Fig. 63.) And here a strange destiny brought two men together.
In 1537, another pilgrim was working in Venice waiting to be joined
by his six disciples. After long years of probation, Ignatius Loyola
was ready to start on the conquest of a very different world. Devoted
to the sick and to the poor, he attached himself to the Theatiner
Order, and in the wards of the hospital and the quadrangle, the
fiery, dark-eyed, little Basque must frequently have come into contact
with the sturdy young Belgian, busy with his clinical studies and his

VESALIUS 151

anatomy. Both were to achieve phenomenal success — the one in a few
years to revolutionize anatomy, the other within twenty years to be
the controller of universities, the counsellor of kings, and the founder
of the most famous order in the Roman Catholic Church. It was in
this hospital that Vesalius made observations on the China-root, oiv^'
which he published a monograph in 1546. The Paduan School was
close to Venice and associated with it, so that the young student had
probably many opportunities of going to and fro. On the sixth of
December, 1537, before he had reached his twenty- fourth year and
shortly after taking his degree, he was elected to the chair of surgery
and anatomy at Padua.

The task Vesalius set himself to accomplish was to give an accurate
description of all the parts of the human body, with proper illustra-
tions. He must have had abundant material, more, probably, than
any teacher before him had ever had at his disposal. We do not know
where he conducted his dissections, as the old amphitheatre has dis-
appeared, but it must have been very different from the tiny one put
up by his successor, Fabricius, in 1594. Possibly it was only a tem-
porary building, for he says in the second edition of the "Fabrica"
that he had a splendid lecture theatre which accommodated more than
five hundred spectators (p. 681).

With Vesalius disappeared the old didactic method of teaching anat-
omy. He did his own dissections, made his own preparations, and,
when human subjects were scarce, employed dogs, pigs or cats, and
occasionally a monkey. For five years he taught and worked at
Padua. He is known to have given public demonstrations in Bologna
and elsewhere. In the "China-root" he remarks that he once taught
in three universities in one year. The first fruit of his work is of great
importance in connection with the evolution of his knowledge. In
1538, he published six anatomical tables issued apparently in single
leaves. Of the famous "Tabulae Anatomicse" only two copies are
known, one in the San Marco Library, Venice, and the other in the
possession of Sir John Stirling-Maxwell, whose father had it repro-
duced in facsimile (thirty copies only) in 1874. Some of the figures
were drawn by Vesalius himself, and some are from the pencil of his
friend and countryman, Stephan van Calcar. Those plates were

152 THE EVOLUTION OF MODERN MEDICINE

extensively pirated. About this time he also edited for the Giunti
some of the anatomical works of Galen."

We know very little of his private life at Padua. His most impor-
tant colleague in the faculty was the famous Montanus, professor of
medicine. Among his students and associates was the Englishman
Caius, who lived in the same house with him. When the output is
considered, he cannot have had much spare time at Padua.

He did not create human anatomy — that had been done by the
Alexandrians — but he studied it in so orderly and thorough a manner
that fof the first time in history it could be presented in a way that
explained the entire structure of the human body. Early in 1542 the
MS. was ready; the drawings had been made with infinite care, the
blocks for the figures had been cut, and in September, he wrote to
Oporinus urging that the greatest pains should be taken with the
book, that the paper should be strong and of equal thickness, the work-
men chosen for their skill, and that every detail of the pictures must
be distinctly visible. He writes with the confidence of a man who
realized the significance of the work he had done. It is difficult to
speak in terms of moderation of the "Fabrica." To appreciate its
relative value one must compare it with the other anatomical works of
the period, and for this purpose I put before you (Fig. 64) two figures
from a text-book on the subject that was available for students during
the first half of the sixteenth century. In figures and text of the
X'Fabrica" we have anatomy as they knew it; and let us be honest and
say, too, largely as Galen knew it. Time will not allow me to go into
the question of the relations of these two great anatomists, but we must
remember that at this period Galen ruled supreme, and was regarded
in the schools as infallible. And now, after five years of incessant
labor, Vesalius was prepared to leave his much loved Padua and his
devoted students. He had accomplished an extraordinary work. He
knew, I feel sure, what he had done. He knew that the MSS. con-
tained something that the world had not seen since the great Pergamite
sent the rolls of his "Manual of Anatomy" among his friends. Too
precious to entrust to any printer but the best — ^and the best in the
middle of the sixteenth century was Cisalpine — he was preparing to go

21 De anatomicis administrationibus, De venarum arteriarumque dissectione, included in the
various Juntine editions of Galen.

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154 THE EVOLUTION OF MODERN MEDICINE

north with the precious burden. We can picture the youthful teacher
— ^he was but twenty-eight — among students in a university which they
themselves controlled — some of them perhaps the very men who five
years before had elected him — at the last meeting with his class,
perhaps giving a final demonstration of the woodcuts, which were of
an accuracy and beauty never seen before by students' eyes, and read-
ing his introduction. There would be sad hearts at the parting, for
never had anyone taught anatomy as he had taught it — no one had
ever known anatomy as he knew it. But the strong, confident look
was on his face and with the courage of youth and sure of the future,
he would picture a happy return to attack new and untried problems.
Little did he dream that his happy days as student and teacher were
finished, that his work as an anatomist was over, that the most bril-
liant and epoch-making part of his career as a professor was a thing
of the past. A year or mqre was spent at Basel with his friend Opori-
nus supervising the printing of the great work, which appeared in 1543
with the title "De Humani Corporis Fabrica." The worth of a book,
as of a man, must be judged by results, and so judged the "Fabrica"
is one of the great books of the world, and would comfe in any century
of volumes which embraced the richest harvest of the human mind. In
medicine, it represents the full flower of the Renaissance. As a book
it is a sumptuous tome — a worthy setting of his jewel — paper, type
and illustration to match, as you may see for yourselves in this folio —
the cJief dfceuvre of any medical library.

In every section, Vesalius enlarged and corrected the work of
Galen. Into the details we need not enter : they are all given in Roth's
monograph, and it is a chapter of ancient history not specially illu-
minating. Np'"'='r did a great piece of literary work have a better
setting. Vesajiius must have had a keen appreciation of the artistic
side of the art of printing, and he must also have realized the fact that
the masters of the art had by this time moved north of the Alps.

While superintending the printing of the precious work in the
winter of 1542-1543 in Basel, Vesalius prepared for the medical school
a skeleton from the body of an executed man, which is probably the
earliest preparation of the kind in Europe. How little anatomy had
been studied at the period may be judged from that fact that there had

VES ALIUS

155

been no dissection at Basel since 1531.'' The specimen is now in the
Vesalium, Basel, of which I show you a picture taken by Dr. Harvey
Gushing. (Fig. 65.) From the typographical standpoint no more
superb volume on anatomy has been issued from any press, except

FIG. 65.

Skeleton prepared by Vesalius at Basel in 1542-1543.

(^Courtesy of Dr. Harvey Gushing.)

indeed the second edition, issued in 1555. The paper is, as Vesalius
directed, strong and good, but it is not, as he asked, always of equal
thickness; as a rule it is thick and hervy, but there are copies on a
good paper of a much lighter quality. The illustrations drawn by
his friend and fellow countryman, van Calcar, are very much in ad-
vance of anything previously seen, except those of Leonardo. The
title-page (Fig. 66) , one of the most celebrated pictr r in the history
of medicine, shows Vesalius in a large amphitheatre (an imaginary one
of the artist, I am afraid) dissecting a female subject. He is demon-
strating the abdomen to a group of students about the table, but
standing in the auditorium are elderly (fAzens and even women. One
student is reading from an open book. There is a monkey on one side
of the picture and a dog on the other. Above the picture on a shield

22 The next, in 1559, is recorded by Plater in his autobiography, who gave a public dissection
during three days in the Church of St. Elizabeth.

B A S I L E AE>
FIG. 66.
Title-page of Epitome (& Fabrica) of Vesalius (154.S).

VESALIUS 157

are the three weasels, the arms of Vesal. The reproduction which I
show you here (Fig. 66) is from the "Epitome" — a smaller work
issued before [ ?] the "Fabrica," with rather larger plates, two of
which represent nude human bodies and are not reproduced in the
great work. The freshest and most beautiful copy is the one on vellum
which formerly belonged to Dr. Mead, now in the British Museum,
and from it this picture was taken. One of the most interesting fea-
tures of the book are the full-page illustrations of the anatomy of the
arteries, veins and nerves. They had not in those days the art of
making corrosion preparations, but they could in some way dissect to
their finest ramifications the arteries, veins and nerves, which were then
spread on boards and dried. Several such preparations are now at the
College of Physicians in London, brought from Padua by Harvey.
The plates of the muscles are remarkably good, more correct, though
not better perhaps, on the whole, than some of Leonardo's.

Vesalius had no idea of a general circulation. Though he had
escaped from the domination of the great Pergamite in anatomy, he
was still his follower in physiology. The two figures annexed (Figs.
67 and 68) , taken from one of the two existing copies of the "Tabulae
Anatomicse," are unique in anatomical illustration, and are of special
value as illustrating the doctrine of the circulation that prevailed until
Harvey's day. I have already called your attention to Galen's view of
the two separate systems, one containing the coarse, venous blood for
the general nutrition of the body, the other the arterial, full of a
thinner, warmer blood with which were distributed the vital spirits and
the vital heat. The veins had their origin in the liver; the superior
vena cava communicated with the right heart, and, as Galen taught,
some blood was distributed to the lungs; but the two Systems were
closed, though Galen believed there was a communication at the 1
periphery between the arteries and veins. Vesalius accepted Galen's
view that there is some communication between the venous and arterial
systems through pores in the septum of the ventricles, though he had
his doubts, and in the second edition of his book (1555) says that in
spite of the authority of the Prince of Physicians he cannot see how the
smallest quantity of blood could- be transmitted through so dense a
muscular septum. Two years before this (1553),* his old fellow stu-
dent, Michael Servetus, had in his "Christianismi Restitutio" an-

* See the Servetus Notes in the Osier Anniversary Volumes, New York, 1919, Vol. 11. — Ed.

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VES ALIUS

159

lOACHrMVM SOBI.ANTS Bplj. Ifl

aiSs ad qdatftum arte parandutn immatura , & di'
fccndtcomuniacpftudiaprouehendiiibidoafedl^rf
kuitcrpemiIerunt.Vtmeamtcrimpraeter<!anldili
genci'am,quatribus fntegrisut ilimtmum ieptima>-
nis,nieinpubl(ds'fc(!Honibusuri uiderutit,quiirt
t Italia miliianatomendo«ntiadfiicrc:quumtaniert '
I tino anno in tribus Academics aliquando id pf scfti-
\ terim.adeo ut G in hoc tempua (criptioh^m diftulif'
i km , & iam prinium coiftioncm aggrederer , mci
'" Anatomidconatusinftudioforum manibushaud
uofar?tur:qui numruodlo Me(uc,ud rtcocSo Gi
(inaria, udrccofto nelho cuius StCpbani dt rriorba
*um diff crcndjs , corundcrtitp cau&s^fyn)ptdmi>
t(inidiiFerentiis,caufi^<:^,tabulis,uctdcniu recoct
parti phai*macopolail]iii SeeuktiTii,iipoReriat£
praeferentur,nefcio. QuoducrdatdnecadAnnd/
tationes , quae in idgens uolumen cccreuetant ,il]£
cumintegra in decern librosRhazes adAlnlanfoJ
Km regem par aphcaii , mu)to diUgendus qaJtm ill4 .
quae in nonum Imnim prole's me confcripta i & U
bricuiufdam demediqtitientorum ferinuLLs appa/
iPatu(in cuius materiammulcameo iudido non ihu>
tiliaconEelterani)unadienuhiincerierunt,cuitidm
iiibus Galeni libtis , qtiibus tga in^dilceUda aiiito^
meufus eram,quosicp, ut fit,uarii comttiaaJauatj
Quum enim aulam adicums,Itallam relinqu^em^
ltcpilliquasnoftimedid,dcmds Ubtisomnibusc^
qushodie prom oueftdisftudi^seduntui'^pud Cat
direnii&aiios quoidam itiagnates peHutiam fedf>
^t cenruTam,ea omnia (in poftcrum manus fadl^
& fcribendo cohibitums ) crent^ui: etfi no.iemdin/
terim,eius pcculantiainiepcxnicueift j mei^ itako^
nMi,quiaderant^Ortiti£nonftetifl<,dolueriitl. '
Qlianquam d^AaiKMsitionibus eo nomine n^it
-" Bb a tncdiocriur

FIG. 69.

Page from Vesalius' Epistle on
China-root (1546).

nounced the lesser circulation. Evi-
dently they had not kept in anatomi-
cal touch with one another!

The puWication of the "Fabrica"
shook the medical world to its foun-
dations. Galen ruled supreme in the
schools: to doubt him in the least
particular roused the same kind of
feeling as did doubts on the verbal
inspiration of the Scriptures fifty
years ago! His old teachers in Paris
were up in arms: Sylvius, nostrce
cetatis medicorum decus, as Vesalius
calls him, wrote furious letters, and
later spoke of him as a madman
(vcesanus). -The younger men were
with him and he had many friends,
but he had aroused a roaring tide of
detraction against which he protested
a few years later in his work on the
"China-root," which is full of details
about the "Fabrica." In a fit of
temper he threw his notes on Galen
and other MSS. in the fire. No

sadder page exists in medical writ-
ings than the one in which Vesalius tells of the burning of his books
and MSS. It is here reproduced and translated.^^ His life for a
couple of years is not easy to follow, but we know that in 1546 he;
took service with Charles V as his body physician, and the greatest/
anatomist of his age was lost in the wanderings of court and cam-

23 Epistle on China-root, 1546, p. 196. Vesalius may be quoted in explanation — in palliation:
"All these impediments I made light of; for I was too young to seek gain by my art, and I
was sustained by my eager desire to learn and to promote the studies in which I shared. I
say nothing of my diligence in anatomizing — those who attended my lectures in Italy know
how I spent three whole weeks over a single public dissection. But consider that in one year I
once taught in three different universities. If I had put off the task of writing till this time;
if I were now j ust beginning to digest my materials ; students would not have had the use of -
ray anatomical labours, which posterity may or may not judge superior to the r6chauff4s
formerly in use, whether of Mesua, of Gatinaria, of some Stephamis or other on the differences,
causes and symptoms of diseases, or, lastly, of a part of Servitor's pharmacopoeia. As to my
notes, which had grown into a huge volume, they were all destroyed by me; and on the same

160 THE EVOLUTION OF MODERN MEDICINE

paigns. He became an active practitioner, a distinguished surgeon,
much consulted by his colleagues, and there are references to many of
his cases, thp most important of which are to internal aneurysms,
which he was one of the first to recognize. In 1555 he brought out the
second edition of the "Fabrica," an even more sumptuous volume than
the first.

There is no such pathetic tragedy in the history of our profession.
Before the age of thirty Vesalius had effected a revolution in anatomy;
he became the valued physician of the greatest court of Europe; but
call no man happy till he is dead ! A mystery surrounds his last days.
The story is that he had obtained permission to perform a post-mortein
examination on the body of a young Spanish nobleman, whom he had
attended. When the body was opened, the spectators to their horror
saw the heart beating, and there were signs of life ! Accused, so it is
said, by the Inquisition of murder and also of general impiety he only
escaped through the intervention of the King, with the condition that
he make a pilgrimage to the Holy Land. In carrying this out in 1564
he was wrecked on the island of Zante, where he died of a fever or of
exhaustion, in the fiftieth year of his age.

To the North American Review^ November, 1902, Edith Wharton
contributed a poem on "Vesalius in Zante," in which she pictures his
life, so full of accomplishment, so full of regrets — regrets accentuated
by the receipt of an anatomical treatise by Fallopius, the successor to
the chair in Padua! She makes him say:

There are two ways of spreading light; to be
The candle or the mirror that reflects it.
I let my wick bum out — there yet remains
To spread an answering surface to the flame
That others kindle.

day there similarly perished the whole of my paraphrase on the ten books of Rhazes to King
Almansor, which had been composed by me with far more care than the one which is prefaced
to the ninth boolc. With these also went the books of some author or other on the formulae and
preparation of medicines, to which I had added much matter of my own which I judged to be
not without utility; and the same fate overtook all the books of Galen which I had used in
learning anatomy, and which I had liberally disfigured in the usual fashion. 1 was on the point
of leaving Italy and going to Court; those physicians you know of had made to the Emperor
and to the nobles a most unfavourable report of my books and of all that is published nowa-
days for the promotion of study; I therefore burnt all these works that I have mentioned,
thinking at the same time that it would be an easy matter to abstain from writing for the
future. I must show that I have since repented more than once of my impatience, and
regretted that I did not take the advice of the friends who were then with me."

— w le

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Vesalius.

Leonardo.
FIG. 70.

Vandyke Carter (1856).

Spines from Vesalius and Leonardo, with a modern drawing of the spine as
a control (showing superiority of the Leonardine delineation).

162 THE EVOLUTION OF MODERN MEDICINE

But between Mundinus and Vesalius, anatomy had been studied by
a group of men to whom I must, in passing, pay a tribute. The great
artists Raphael, Michael Angelo and Albrecht Diirer were keen stu-
dents of the human form. There is an anatomical sketch by Michael
Angelo in the Ashmolean Museum, Oxford, which I here reproduce.*
Diirer's "famous work on "Human Proportion," published in 1528,
contains excellent figures, but no sketches of dissections. But greater
than any of these, and antedating them, is Leonardo da Vinci, the one
universal genius in whom the new spirit was incarnate — the Moses
who alone among his contemporaries saw the promised land. How
far Leonardo was indebted to his friend and fellow student, della
Torre, at Pavia we do not know, nor does it matter in face of the
indubitable fact that in the many anatomical sketches from his hand
we have the first accurate representation of the structure of the body.
Glance at the three figures of the spine which I have had photographed
side by side, one from Leonardo, one from Vesalius and the other from

* This plate was lacking among the author's illustrations, but the Keeper of the Ashmolean
Museum remembers his repeatedly showing special interest in the sketch reproduced in Charles
Singer's Studies in the History and Method of Science, with an Introduction by Sir Wm.
Osier (Vol. I), Oxford, 1917, p. 97 (also in J., A. Symonds's Life of Michelangelo, London,
1893, Vol. I, p. 44), representing Michael Angelo and a friend dissecting the body of a man,
by the light of a candle fixed in the body itself. — Ed.

Leonardo.

Vesalius.

FIG. 71.

Figures of bones of the foot from
Leonardo and Vesalius.

HARVEY 163

Vandyke Carter, who did the drawings in Gray's "Anatomy" (1st
ed., 1856). They are all of the same type, scientific, anatomical
drawings, and that of Leonardo was done fifty years before Vesalius !
Compare, too, this figure of the bones of the foot with a similar one
from Vesalius/* (Fig. 71.) Insatiate in experiment, intellectually
as greedy as Aristotle, painter, poet, sculptor, engineer, architect,
mathematician, chemist, botanist, aeronaut, musician and withal a
dreamer and mystic, full accomplishment in any one department was
not for him! A passionate desire for a mastery of nature's secrets
made him a fierce thing, replete with too much rage! But for us a
record remains — Leonardo was the first of modern anatomists, and
fifty years later, into the breach he made, Vesalius entered.^'^

HARVEY

Let us return to Padua about the year 1600. Vesalius, who made(~:4^
the school the most famous anatomical centre in Europe, was suc-'^^^
ceeded by Fallopius, one of the best-known names in anatomy, at
whose death an unsuccessful attempt was made to get Vesalius back.
He was succeeded in 1.565 by a remarkable man, Fabricius (who
usually bears the added name of Aquapendente^ from the town of his
birth), a worthy follower of Vesalius. In 1594, in the thirtieth year
of Iris professoriate, he built at his own expense a new anatomical
amphitheatre, which still exists in the ijniversity buildings. It is a
small, high-pitched room with six standing-rows for auditors rising
abruptly one above the other. The arena is not much more than large
enough for the dissecting table which, by a lift, could be brought up
from a preparing room below. The study of anatomy at Padua must
have declined since the days of Vesalius if this tiny amphitheatre held
all its students; none the less, it is probably the oldest existing ana-
tomical lecture room, and for us it has a very special significance.

Early in his anatomical studies Fabricius had demonstrated the
valves in the veins. I show you here two figures (Figs. 72 and 73),
the first, so far as I know, in which these structures ate depicted. It

2* He was the first to make and represent anatomical cross sections. See Leonardo;
Qu^dernl d'Anatomla, Jacob Dybwad, Krlstiania, 1911-1916, Vol. V.

25 See Knox: Great Artist.s and Great Anatomists, London, 1852, and Mathias Duval in Les
Manuscrits de Leonard de Vince: De I'Anatomie, Feuillets A, Edouard Rouveyre, Paris, 1898.
For a good account of Leonardo da Vinci see Merejkovsky's novel, The Forerunner, London,
1902, also New York, Putnam.

FIG. 72.

Plates from Fabricius, showing
valves in the veins (1603).

FIG. 73.

Showing the method of demonstrating valves
in veins of arm (1603).

HARVEY 165

does not concern us who first discovered them ; they had doubtless been
seen before, but Fabricius first recognized them as general structures
in the venous system, and he called them little doors — "ostiola."

The quadrangle of the university building at Padua is surrounded
by beautiful arcades, the walls and ceilings of which are everywhere
covered with the stemmata, or shields, of former students, many of
them brilliantly painted. Standing in the arcade on the side of the
"quad" opposite the entrance, if one looks- on the ceiling immediately
above the capital of the second column to the left there is seen the
stemma which appears as tailpiece to this chapter, put up by a young
Englishman, William Harvey, who had been a student at Padua for
four years. He belonged to the "Natio Anglica," of which he was
Conciliarius, and took his degree in 1602. Doubtless he had repeatedly
seen Fabricius demonstrate the valves of the veins, and he may indeed,
as a senior student, have helped in making the very dissections from
which the drawings were taken for Fabricius' work, "De Venarum
Osteolis," 1603. If one may judge from the character of the teacher's
work the sort of instruction the student receives, Harvey must have
had a splendid training in anatomy. While at Padua the great work
of Fabricius, "De Visione, Voce et Auditu," 1600, was published, and
the "Tractatus de Oculo Visusque Organo," 1601, and in the last year
of his residence Fabricius must have been busy with his studies on the
valves of the veins and with his embryology, which appeared in 1604. ^
Late in life, Harvey told Boyle that it was the position of the valves
of the veins that induced him to think of a circulation.

Harvey returned to England trained by the best anatomist of his
day. In London, he became attached to the College of Physicans, and
taking his degree at Cambridge, he began the practice of medicine.
He was elected a fellow of the college in 1607 and physician to St.
Bartholomew's Hospital in 1609. In 1615 he was appointed Lum-
leian lecturer to the College of Physicians, and his duties were to hold
certain "public anatomies," as they were called, or lectures. We know
little or nothing of what Harvey had been doing other than his routine
work in the care of the patients at St. Bartholomew's. It was not
until April, 1616, that his lectures began. Chance has preserved to
us the notes of this first course; the MS. is now in the British Museum
and was published in facsimile by the college in 1886.'°

26 William Harvey: Prelectiones Anatomiae Universalis, London, J. & A. Churchill, 1886.

166 THE EVOLUTION OF MODERN MEDICINE

The second day lecture, April 17, was concerned with a description
of the organs of the thorax, and after a discussion on the structure and
action of the heart come the lines :

W. H. constat per fabricam cordis sanguinem
per pulmones in Aortam perpetuo
transferri, as by two clacks of a
water bellows to rayse water
constat per ligaturam transitum sanguinis
ab arteriis ad venas
unde perpetuum sanguinis motum
in circulo fieri pulsu cordis.

The illustration (Fig. 74) will give you an idea of the extraor-
dinarily crabbed hand in which these notes are written, but it is worth
while to see the original, for here is the first occasion upon which is
laid down in clear and unequivocal words that the blood circulates.
The lecture gave evidence of a skilled anatomist, well versed in the
literature from Aristotle to Fabricius. In the MS. of the thorax, or,
as he calls it, the "parlour" lecture, there are about a hundred refer-
ences to some twenty authors. The remarkable thing is that although
those lectures were repeated year by year, we have no evidence that
they made any impression upon Harvey's contemporaries, so far, at
least, as to excite discussions that led to publication. It was not until
y twelve years later, 1628, that Harvey published in Frankfurt a small
quarto volume of seventy-four pages,^^ "De Motu Cordis." In com-
parison with the sumptuous "Fabrica" of Vesalius this is a trifling
booklet; but if not its equal in bulk or typographical beauty (it is in
fact very poorly printed) , it is its counterpart in physiology, and did
for that science what Vesalius had done for anatomy, though not in
the same way. The experimental spirit was abroad in the land, and as
a student at Padua, Harvey must have had many opportunities of
learning the technique of vivisection; but no one before his day had
attempted an elaborate piece of experimental work deliberately
planned to solve a problem relating to the most important single
function of the body. Herein lies the special merit of his work, from
every page of which there breathes the modern spirit. To him, as to
Vesalius before him, the current views of the movements of the blood

27 Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, Francofurti,
1628.

\AH conftat per fabricam cordis fanguinem
per pulmones in Aortam perpetuo
tranfferri, as by two clacks of a
water bellows to rayfc water
conftat per ligaturam tranfitum fanguinis
ab artcrijs ad venas
vnde A perpetuuni fanguinis motum
in circulo fieri pulfu cordis
An ? hoc gratia Nutritionis
an magis Confervationis fanguinis
et Membrorum per Infufionem calidam
viciffimque fanguis Calefaciens
membra frigifa^lum a Corde
Calefit

>:• ^vr^-^^ M tW^ r*^ I

FIG. 74.
Page from Harvey's lecture of April 17, 1616.

eXEKCITAHIO

ANATOMICADE

MO 'TV CORDIS ET SAN-

GVINIS IN ANIMALI.

qVILlELMI HARVEJ AKGLh

MedtciR^gH, ^ Trofeforis aAnatpmU in CoU

FIG. 75.
Title-page of Harvey's Treatise on Circulation of the Blood (1628).

HARVEY 169

were unsatisfactory, more particularly the movements of the heart
and arteries, which were regarded as an active expansion by which
they were filled with blood, like bellows with air. The question of the
transmission of blood through the thick septum and the transference
of air and blood from the lungs to the heart were secrets which he was
desirous of searching out by means of experiment.

One or two special points in the work may be referred to as illus-
trating his method. He undertook first the movernients of the heart,
a task so truly arduous and so full of difficulties that he was almost
tempted to think with Fracastorius that "the movement of the heart
was only to be comprehended by God." But after many difficulties he
made the following statements: first, that the heart is erected and
raises itself up into an apex, and at this time strikes against the breast
and the pulse is felt externally ; second, that it is contracted everyway,
but more so at the sides ; and thirdly, that grasped in the hand it was
felt to become harder at the time of its motion; from all of which
actions Harvey drew the very natural conclusion that the activity of
the heart consisted in a contraction of its fibres by which it expelled the
blood from the ventricles. These were the first four fundamental facts
which really opened the way for the discovery of the circulalion, as it
did away with the belief that the heart in its motion attracts blood into
the ventricles, stating on the contrary that by its contraction it
expelled the blood and only received it during its period of repose or
relaxation. Then he proceeded to study the action of the arteries and
showed that their period of diastole, or expansion, corresponded with
the systole, or contraction, of the heart, aftd tha^ the arterial pulse
follows the force, frequency and rhythm of the ventricle and is, in fact,
dependent upon it. Here was another new f actlithat the pulsation in
the arteries was nothing else than the impulse of the blood within them.
Chapter IV, in which he describes the movements of the auricles and
ventricles, is a model of accurate description, to which little has since
been added. It is interesting to note that he mentions what is prob-
ably auricular fibrillation. He says: "After the heart had ceased pul-
sating an undulation or palpitation remained in the blood itself which
was contained in the right auricle, this being observed so long as it was
imbued with heat and spirit." He recognized too the importance of the
auricles as the first to move and the last to die. The accuracy and
vividness of Harvey's description of the motion of the heart have been

170 THE EVOLUTION OF MODERN MEDICINE

appreciated by generations of physiologists. Having grasped this
^rst essential fact, that the heart was an organ for the propulsion of
blood, he takes up in Chapters VI and VII the question of the con-
veyance of the blood from the right side of the heart to the left. Galen
had already insisted that some blood passed from the right ventricle to
the lungs — enough for their nutrition; but Harvey points out, with
Colombo, that from the arrangement of the valves there could be no
other view than that with each impulse of the heart blood passes from
the right ventricle to the lungs and so to the left side of the heart.
How it passed through the lungs was a problem: probably by a con-
tinuous transudation. In Chapters VIII and IX he deals with the
amount of blood passing through the heart from the veins to the
arteries. Let me quote here what he says, as it is of cardinal import:

"But what remains to be said upon the quantity and source of the
blood which thus passes, is of a character so novel and unheard of that
I not only fear injury to myself from the envy of a few, but I tremble
lest I have mankind at large for my enemies, so much doth wont and
custom become a second nature. Doctrine once sown strikes deeply
its root, and respect for antiquity influences all men. Still the die is
cast, and my trust is in my love of truth, and the candour-of cultivated
minds. '"^ Then he goes on to say :

"I began to think whether there might not be a movement^ as it
WEEE, IN A CIRCLE. Now this I afterwards foimd to be true; and I
finally saw that the blood, forced by the action of the left ventricle
into the arteries, was distributed to the body at large, and its several
parts, in the same manner as it is sent through the lungs, impelled by
the right ventricle into the pulmonary artery, and -that it then passed
through the veins and along the vena cava, and so round to the left
ventricle in the manner already indicated.'"''

The experiments dealing with the transmission of blood in the veins
are very accurate, and he uses the old experiment that Fabricius had
employed to show the valves, to demonstrate that the blood in the
veins flows towards the heart. For the first time a proper explanation
of the action of the valves is given. Harvey had no appreciation of
how the arteries and veins communicated with each other. Galen, you

28 William Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus,
Francofurti, 1638, G. Moreton's facsimile reprint and translation, Canterbury, 1894, p. 48.

29 Ibid., p. -49.

HARVEY

171

may remember, recognized that there were anastomoses, but Harvey
preferred the idea of filtration.

The "De Motu Cordis" constitutes a unique piece of work in the
history of medicine. Nothing of the same type had appeared before.
It is a thoroughly sensible, scientific study of a definite problem, the
solution of which was arriA^ed at through the combination of accurate
observation and ingenious experiment. Much misunderstanding has

FIG. 76.
Plate from Harvey, repeating the experiment of Fabricius.

arisen in connection with Harvey's discovery of the circulation of the
blood. He did not discover that the blood moved, — that was known to
Aristotle and to Galen, from both of whom I have given quotations
which indicate clearly that they knew of its movement, — but at the
time of Harvey not a single anatomist had escaped from the domina-
tion of Galen's views. Both Servetus and Colombo knew of the pul-
monary circulation, which was described by the former in very accurate
terms. Cesalpinus, a great name in anatomy and botany, for whom is
claimed the discovery of the circulation, only expressed the accepted
doctrines in the following oft-quoted phrase :

"We will now consider how the attraction of aliment and the process
of nutrition takes place in plants; for in animals we see the aliment
brought through the veins to the heart, as to a laboratory of innate
heat, and, after receiving there its final perfection, distributed through

172 THE EVOLUTION OF MODERN MEDICINE

the arteries to the body at large, by the agency of the spirits produced
from this same ahment in the heart."^° There is nothing in this but
Galen's view, and Cesalpinus believed, as did all his contemporaries,
that the blood was distributed through the body by the vena cava and
its branches for the nourishment of all its parts.* To those who have
any doubts as to Harvey's position in this matter I would recommend
the reading of the "De Motu Cordis" itself, then the various. passages
relating to the circulation from Aristotle to Vesalius. Many of these
can be foimd in the admirable works of Dalton, Flourens, Richet and
Curtis/^ In my Harveian Oration for 1906^' I have dealt specially
with the reception of the new views, and have shown how long it was
before the reverence for Galen allowed of their acceptance. The Uni-
versity of Paris opposed the circulation of the blood for more than
half a century after the appearance of the "De Motu Cordis."

To summarize — until the seventeenth century there were believed
-to be two closed systems in the circulation, ( 1 ) the natural, containing
venous blood, had its origin in the liver from which, as from a fountain,
the blood continually ebbed and flowed for the nourishment of the
body; (2) the vital, containing another blood and the spirits, ebbed
and flowed from the heart, distributing heat and life to all parts. Like
a bellows the lungs fanned and cooled this vital blood. Here and there
we find glimmering conceptions of a communication between these
systems, but practically all teachers believed that the only one of im-
portance was through small pores in the wall separating the two sides
of the heart. Observation — merely looking at and thinking about
things — had done all that was possible, and further progress had to
await the introduction of a new method ; viz.,, experiment. Galen, it is
true, had used this means to show that the arteries of the body con-
tained blood and not air. The day had come when men were no longer
content with accurate description and with finely spun theories and
dreams. It was reserved for the immortal Harvey to put into practice
the experimental method by which he demonstrated conclusively that

30 De Plantis, Lib. I, Cap. 2.

* Cesalpinus has also a definite statement of the circlewise process. — Ed.

31 J. C. Dalton: Doctrines of the Circulation, Philadelphia, 1884; Flourens: Histoire de la
ddcouverte de la circulation du sang, 2d ed., Paris, 1857; Charles Richet: Harvey, la circulation
du sang, Paris, 1879; John G. Curtis: Harvey's Views on the Use of Circulation, etc., New
York, 1915.

32 Osier: An Alabama Student and Other Biographical Essays, Oxford, 1908, p. 395.

HARVEY 173

the blood moved in a circle. The "De Motii Cordis" marks the finaP
break of the modern spirit with the old traditions. It took long for
men to realize the value of this "inventum mirabile" used so effectively
by the Alexandrians — by Galen — indeed, its full value has only been
appreciated within the past century. Let me quote a paragraph from
my Harveian Oration.^^ "To the age of the hearer, in which men had
heard and heard only, had succeeded the age of the eye in which men
had seen and had been content only to see. But at last came the age
of the hand — the thinking, devising, planning hand, the hand as an
instrument of the mind, now re-introduced into the world in a modest
little monograph from which we may date the beginning of experi-
mental medicine."

Harvey caught the experimental spirit in Italy, with brain, eye and
hand as his only aids, but now an era opened in which medicine was
to derive an enormous impetus from the discovery of instruments of -^,
precision. "The new period in the development of the natural
sciences, which reached its height in the work of such men as Galileo,
Gilbert and Kepler, is chiefly characterized by the invention of very
important instruments for aiding and intensifying the perceptions of
the senses, by means of which was gained a much deeper insight into
the phenomena than had hitherto been possible. Such instruments as
the earlier ages possessed were little more than primitive hand-made
tools. Now we find a considerable number of scientifically made
instruments deliberately planned for purposes of special research, and
as it were, on the threshold of the period stand two of the most
important, the compound microscope and the telescope. The former
was invented about 1590 and the latter about 1608."''* It was a fellow
professor of the great genius Galileo who attempted to put into prac-
tice the experimental science of his friend. With Sanctorius began the
studies of temperature, respiration and the physics of the circulation.
The memory of this great investigator has not been helped by the
English edition of his "De StaticaJNIedicina," not his best work, with a
frontispiece showing the author in his dietetic balance. (Fig. 77.)
Full justice has been done to him by Dr. Weir Mitchell in an address
as president of the Congress of Physicians and Surgeons, 1891.^*^

33 Osier: An Alabama Student, etc., pp. 329-^30.

3*Danneniann: Die Naturwissenschaften in ilirer Entwickelung . . . , Vol. II, p. 7, Leipzig,'
1911.
35 See Transactions Congress Physicians and Surgeons, 1891, New Haven, 1892, II, 159-181.

174 THE EVOLUTION OF MODERN MEDICINE

Sanctorius worked with a pulsilogue devised for him by Gahleo, with
which he made observations on the pulse. He is said to have been the
first to put in use the clinical thermometer. His experiments on -insen-
sible perspiration mark him as one of the first modern physiologists.

But neither Sanctorius nor Harvey had
the immediate influence upon their con-
temporaries which the novel and stimulat-
ing character of their work jiistified.
Harvey's great countryman, Bacon, al-
though he lost his life in making a cold
storage experiment, did not really appre-
ciate the enormous importance of experi-
mental science. He looked very coldly
upon Harvey's work. It was a philoso-
pher of another kidney, Rene. Descartes,
who did more than anyone else to help
men to realize the value of the better way
which Harvey had pointed out. That
the beginning of wisdom was in doubt,
not in authority, was a novel doctrine in,
the world, but Descartes was no armchair
philosopher, and his strong advocacy and
practice of experimentation had a pro-
found influence in directing men to "la
nouxwlle methode." He brought the hu-
man body, the earthlj;^ machine, as he calls it, into the sphere of me-
chanics and physics, and he wrote the first text-book of physiology,
"De I'Homme." Locke, too, became the spokesman of the new ques-
tioning spirit, and before the close of the seventeenth century, experi-
mental research became all the mode. Richard Lower, Hooke and
Hales -were probably more influenced by Descartes than by Harvey,
and they made notable contributions to experimental physiology in
England. Borelli, author of the famous work on "The Motion of
Animals" (Rome, 1680-1681), brought to the study of the action
of muscles a profound knowledge of physics and mathematics and
really founded the mechanical, or iatromechanical school. The litera-
ture and the language of medicine became that of physics and me-
chanics: wheels and pulleys, wedges, levers, screws, cords, canals,

FIG. 77.

Frontispiece of Sanctorius' De
Statica Medicina (1614).

FIG. 78.
Rene Descartes.

176 THE EVOLUTION OF MODERN MEDICINE

cisterns, sieves and strainers, with angles, cylinders, celerity, percus-
sion and resistance, were among the words that now came into use in
medical literature. Withington quotes a good example in a descrip-
tion by Pitcairne, the Scot who was professor of medicine at Leyden at
the end of the seventeenth century. "Life is the circulation of the
blood. Health is its free and painless circulation. Disease is an ab-
normal motion of the blood, either general or local. Like the English
school generally, he is far more exclusively mechanical than are the
Italians, and will hear nothing of ferments or acids, even in digestion.
This, he declares, is a purely niechanical process due to heat and pres-
sure, the wonderful effects of which may be seen in Papin's recently
invented 'digester.' That the stomach is fully able to comminute the
food may be proved by the following calculation. Borelli estimates
the power of the flexors of the thumb at 3720 pounds, their average
weight being 122 grains. Now, the average weight of the stomach is
eight ounces, therefore it can develop a force of 117,088 pounds, and
this may be further assisted by the diaphragm and abdominal muscles
the power of which, estimated in the same way, equals 461,219 pounds!
Well may Pitcairne add that this force is not inferior to that of any
millstone."^" Paracelsus gave an extraordinary stimulus to the study
of chemistry and more than anyone else he put the old alchemy on
modern lines. I have already quoted his sane remark that its chief
7 service is in seeking remedies. But there is another side to this ques-
tion. If, as seems not improbable, the Basil Valentine whose writings
were supposed to have inspired Paracelsus was a hoax and his works
were made up in great part from the writings of Paracelsus, then to
our medical Luther, and not to the mythical Benedictine monk, must
be attributed a great revival in the search for the Philosopher's Stone,
for the Elixir of Life, for a universal medicine, for the perpetuum
mobile and for an aurum potahile.^'' I reproduce, almost at random, a
page from the fifth and last part of the last will and testament of Basil
Valentine (London, 1671), from which you may judge the chemical
spirit of the time. (Fig. 79.)

Out of the mystic doctrines of Paracelsus arose the famous

36 Withington: Medical History from the Earliest Times, London, 1894, Scientific Press,
p. 317.

37 See Professor Stillman on the Basil Valentine hoax, Popular Science Monthly, New
York, 1913, LXXXI, 591-600.

HARVEY 177

"Brothers of the Rosy Cross." "The brotherhood was possessed of
the deepest knowledge and science, the transmutation of metals, the
perpetuum mobile and the universal medicine were among their
secrets; they were free from sickness and suffering during their
lifetime, though subject finally to death. "^*

38 Ferguson: Bibliotheca Chemica, Vol. II, p. 290. For an account of Fludd and the
English Rosicrucians see Craven's Life of Fludd, Kirkwall, 1902.

Sf of tht fupermtural

Therefore if God doth bliffii thre with i troe knowledge
Jiercof,thai you w>iu;d ketp thu Jnretum in fileice and
privacy, Icaft you turn Gods bltfllnginto a curfe:bccaufe
thepi«pai*<.ionofi:his,ar.dofch«Aoneisone, both have
their originaUand brlt generation, aod birth from the true
feed, and AftfO*ogick primum mbile, jailed the fpirit of
Mercilry.ofvi'hieh'formtrly i have w(i, ten more largely.
For I fpcak ihehigheft rru h unto ihee , that neither the
Upivert«l *or 'Particular Tu Sure , he'i'htr aurum potakiU,*
.nor oih#i' tliipcff *l Midicine ,mtho\Jt this, heavenly and
fpiimal effrncc, which hath its oiigind from-tbe f^arry
}ie^veii,iakethandrrctiv£th the fame, from thence tnay
be had and prepared, .hciefore be fileijc rill dtjth , at your
' departing )ay down again youi talcnr,a!> I bive done j fcr if I
bi6 lut iiifoi tntd you f3trhfuIlv,you wgu'.d kn^w but lir-ls
of ihjt rnv(tes>,and'c'>ntiiiu« ftnJ withahe vul^r Irj "frilly,
blindreiTe.aud madneflfe, and yr u would have fent a Recipe
into the greafy apd falvy fjjopi of Apotheories, b«c whither
V^ould thy Soul hiw gone after thy depanpre ? into Galtwi
lap, ro -h» iitmoft dtpjh of darkreffe, where the Dcvtls hsvc
tneir dwelling plMeSjCveo thither, both thy foul and body
-WfuH have been rent, in cafe thou (houldfl have divulged
k^vofthflelfcreu.

' To .urn to my intended bufioefTe, I will in the'fiif! place
inform yoo, what T$ that true and highefl aurum potabik^
tnd unlvtrfal Meclicist,»frtt tl.jt in' order there followeth
■znot^iot aurum pottkiU tatit of the fivedied Suiphur, or
Soulof the corporeal Gold, m'oft highly purged, ied is pre-
pared with rheconjaiiflJon of the Univerfal spirit of Mer-
curie. After this. «h«rc followerh another Particutar Medi-
tine, which is half an aurnm potabik , /heaving in efficacie
ard power inmany (ryals. Then I will add thereun-o a de-
rcrip;ionof«(r«wp»/<A»?e,bec«ufc it tract; h the ftcp^ of
Gold , and it fheweth wonderfully its great etiergy and
verruts.

■ The high' ft and cKirfefl aurum pottbilf , which the Lord
God hash laid into nature, is the excodcd, prepared, and
C- ■ ' fixed'

FIG. 79.
Page from the last testament of Basil Valentine (1671).

178 THE EVOLUTIOlSr OF MODERN MEDICINE

A school of a more rational kind followed directly upon the work of
Paracelsus, in which the first man of any importance was Van Hel-
mont. The Paracelsian Archaeus was the presiding spirit in living
creatures, and worked through special local ferments, by which the
functions of the organs are controlled. Disease of any part represents
a strike on the part of the local Archasus, who refuses to work.
Though full of fanciful ideas. Van Helmont had the experimental
spirit and was the first chemist to discover the diversity of gases.
Like his teacher, he was in revolt against the faculty, and he has bitter
things to say of physicians. He got into trouble with the Church
about the magnetic cure of wounds, as no fewer than twenty-seven
propositions incompatible with the Catholic faith were found in his
pamphlet (Ferguson). The Philosophus per ignem, Toparcha in
Merode, Royenborch, as he is styled in certain of his writings, is not
an easy man to tackle, I show (Fig. 81) the title-page of the "Ortus
Medicinas," the collection of his works by his son. As with the pages
of Paracelsus, there are many gems to be dug out. The counterblast
against bleeding was a useful protest, and to deny in toto its utility in
fever required courage — a quality never lacking in the Father of
Modern Chemistry, as he has been called.

A man of a very different type, a learned academic, a professor of
European renown, was Daniel Sennert of Wittenberg, the first to

introduce the systematic teaching of chemis-
try into the curriculum, and who tried to
harmonize the Galenists and Paracelsians.
Franciscus Sylvius, a disciple of Van
Helmont, established the first chemical
laboratory in Europe at Leyden, and to
him is due the introduction of modern clini-
cal teaching. In 1664 he writes : "I have led
my pupils by the hand to medical practice,
using a method unknown at Leyden, or
perhaps elsewhere, i.e., taking them daily to
visit the sick at the public hospital. There
I have put the symptoms of disease before
their eyes ; have let them hear the complaints
FIG. 80. of the patients, and have asked them their

Daniel Sennert. opinions as to the causes and rational treat-

s' '■■' . . .

DANIIX JENNERTTl.'!, p. PROfEf.'!.
PUBL 5EKI0R, ETwfERENIJA
SAX. ELECT. JOH,GE0R.G,I.FEE
MEMOR..AR,C HI ATEK.

HARVEY 179

ment of each case, arid the reasons for those opinions. Then I have
given my own judgment on every point. Together with me they have
seen the happy results of treatment when God has granted to our

ORTVS Jvlj&DICINiE.

' INITIA PHYSIci INAVDITA.

ProgreflusmediciniEnovus, ,:

M O R B O R U M U L T I O N E M,

.^ A D

V I T A M L O N GAM.

A P T H R e ^

lOANNE BAPTISTA VAN HELM ON T,

Toparcha in Mcrode , Roy enborcli, Oorfchot, Pdlincsj &c.

^^ Ziiente A u T H o R 1 s Tilio,

FRANCISCO MERCVRIO VAN HELMONT,
■>■ Cum ejus Pr^fatione ex Belgico tranQatl.

AMSTntODAUl,

Apud Ludovicum Elzevirium,

cId I D c XLV.III.

FIG. 81.
Title-page of Van Helmont's Ortus Medicinae (1648).

cares a restoration of health; or they have assisted in examining the
body when the patient has paid the inevitable tribute to death.'"^

Glauber, Willis, Mayow, Lemery, Agricola and Stahl led up to
Robert Boyle, with whom modern chemistry may be said to begin.

39 Withington: Medical History from the Earliest Times, London, 1894, pp. 312-313.

180 THE EVOLUTION OF MODERN MEDICINE

Even as late as 1716, Lady Mary Wortley Montagu in Vienna found
that all had transferred their superstitions from religion to chemistry;
"scarcely a man of opulence or fashion that has not an alchemist in his
service." To one scientific man of the period I must refer as the
author of the first scientific book published in England. Dryden

sings :

Gilbert shall live till load-stones cease to draw
Or British fleets the boundless ocean awe.

FIG. 82.
Robert Boyle.

GVILIELMI GIL

BERT I COLCESTREN-

SIS, MEDICI LONDI-
NENSISj

DE MAGNETE, MAGNETI-
ciSQjVE coRPORiBvs, ET DE MAG-

no niagnete tellurC; Pliyfiologia noaa,

pkrimis 6^ argumentis y O ex^i"

rimentis dcmonftrau*

LONDINl

EXCVDEBAT PetrvsShortANNO

MDC.

FIG. 83.
Title-page (reduced) of William Gilbert's Treatise on the Magnet (1600).

182 THE EVOLUTION OF MODERN MEDICINE

And the verse is true, for by the pubUcation in 1600 of the "De
Magnete" the science of electricity was founded. William Gilbert
was a fine type of the sixteenth-century physician, a Colchester man,
educated at St. John's College, Cambridge. Silvanus Thompson
says: "He is beyond question rightfully regarded as the Father of
Electric Science. He founded the entire subject of Terrestrial
Magnetism. He also made notable contributions to Astronomy, being
the earliest English expounder of Copernicus. In an age given over
to metaphysical obscurities and dogmatic sophistry, he cultivated the
method of experiment and of reasoning from observation, with an
insight and success which entitles him to be regarded as the father of
the inductive method. That method, so often accredited to Bacon,
Gilbert was practising years before him."*°

*« Silvanus P. Thompson: Gilbert of Colchester, Father of Electrical Science, London,
Chiswick Press, 1903, p. 3.

FIG. 84.

Harvey's stemma set in the
v(^alls of the university at
Padua (with caduceus).

CHAPTER V

THE RISE AND DEVELOPMENT OF
MODERN MEDICINE

THE middle of the seventeenth century saw the profession thus
far on its way^ — certain objective features of disease were
known, the art of careful observation had been cultivated,
many empirical remedies had been discovered, the coarser structure of
man's body had been well worked out, and a good beginning had been ^
made in the knowledge of how the machinery worked — nothing more.
What disease really was, where it was^ how it was caused, had not
even begun to be discussed intelligently.

An empirical discovery of the first importance marks the middle
of the century. The story of cinchona is of special interest, as it was
the first great specific in disease to be discovered. In 1638, the wifey*
of the Viceroy of Peru, the Countess of Chinchon, lay sick of an
intermittent fever in the Palace of Lima. A friend of her husband's,
who had become acquainted with the virtues, in fever, of the bark of a
certain tree, sent a parcel of it to the Viceroy, and the remedy admin-
istered by her physician, Don Juan del Vego, rapidly effected a cure.
In 1640, the Countess returned to Spain, bringing with her a supply
of quina bark, which thus became known in Europe as "the Countess's
Powder" [pulvis Comitissce) . A little later, her doctor followed,
bringing additional quantities. Later in the century, the Jesuit
Fathers sent parcels of the bark to Rome, whence it was distributed
to the priests of the community and used for the cure of ague ; hence
the name of "Jesuits' bark." Its value was early recognized by Syden-
ham and by Locke. At first there was a great deal of opposition, and
the Protestants did not like it because of its introduction by the
Jesuits. The famous quack, Robert Talbor, sold the secret of pre-
paring quinquina to Louis XIV in 1679 for two thousand louis d'or, a

184 THE EVOLUTION OF MODERN MEDICINE

X

pension and a title. That the profession was divided in opinion on the
subject was probably due to sophistication, or to the importation of
other and inert barks. It was well into the eighteenth century before
its virtues were universally acknowledged. The tree itself was not
described until 1738, and Linnaeus established the genus "Chinchona"
^in honor of the Countess.^

A step in advance followed the objective study of the changes
wrought in the body by disease. To a few of these the anatomists had

already called attention. Vesalius, always
keen in his description of aberrations from
the normal, was one of the first to describe'^'
internal aneurysm. The truth is, even the
best of men had little or no appreciation of
the importance of the study of these
changes. Sydenham scoffs at the value of
post-mortems.

Again we have to go back to Italy for
the beginning of these studies, this time to
Florence, in the glorious days of Lorenzo
the Magnificent. The pioneer now is not
a professor but a general practitioner, An-
tonio Benivifini, of whom we know very
little save that he was a friend of Marsilio
Ficino and of Angelo Poliziano, and that
he practised in Florence during the last
third of the fifteenth century, dying in
1502. Through associations with the
scholars of the day, he had become a stu-
dent of Greek medicine and he was not only a shrewd and accurate
observer of nature but a bold and successful practitioner. He had
formed the good habit of making brief notes of his more important
cases, and after his death these were found by his brother Jerome and
pubhshed in 1507.' This book has a rare value as the record of the
experience of an unusually intelligent practitioner of the period.
There are in all 111 observations, most of them commendably brief.

1 Clements R. Markham: Peruvian Bark, John Murray, London, 1880; Memoir of the Lady-
Anna di Osoria, Countess of Chinchona and Vice-Queen of Peru, 1874.

2 De abditis nonnuUis ac mirandis morborum et sanationum causis. 8°, Florence, Giunta,
1507.

ANTONII BENIVENn FLOREM^
TINI MEDICI ET PHILOSOPHt
DE ABDITIS NON NVLLIS AG
MIRANDIS MORBORVM ET SA;
NATIONVM CAVSIS .

De morboqucm uulgo Gallicuj uo/
cant. Caput. Primuiti.

OWM MORBI GENVS/
Anno Salutis nonagcfimo fex/
fi to Tupra millc gngentos aChri

ftiana falute non folum Italiay
fed fere totam Europa irrepfit.
HocabHifpaniaincipicns/perltaliamip
fam primum/ turn Galliam czterast^Euro
px prouincias late diffufu^ mortales ^ plu
rimosoccupauit . Incipieoant enim puftu
lacgcneredmerflingenitalibus mcmbiii /
licet intcrdu^ fed rarenter In capite t & inde
per totum corpus diffudebant. Aliis gdcj
plane minimc(^ext3ntes t fed fcabratame
in f uperficie / & colore fubalbidz i a quib'
fguamz refoluebantur / Be caro fub his cor
rofa apparebat . Aliis uarisfimiles figun
rotundz t K ab bis item fquamia leuiorib'
tcfolutis ptomincbat caio lubinmdiot I

FIG. 85.

First page of Benivieni's
De Abditis (l507).

DEVELOPMENT OF MODERN MEDICINE 185

The only one of any length deals with the new "Morbus Gallicus/' of
which, in the short period between its appearance and Benivieni's
death, he had seen enough to leave a very accurate description; and it
is interesting to note that even in those early days mercury was
employed for its cure. The surgical cases are of exceptional interest,
and No. 38 refers to a case of angina for which he performed a suc-
cessful operation. This is supposed to have been a tracheotomy, and
if so, it is the first in the fourteen centuries that had elapsed since the
days of Antyllus.^ There are other important cases which show that
he was a dexterous and fearless surgeon. But the special interest of
the work for us is that, for the first time in modern literature, we have
reports of post-mortem examinations made specifically with a view to
finding out the exact cause of death. Among the 111 cases, there are
post-mortem records of cases of gallstones, abscess of the mesentery,
thrombosis of the mesenteric veins, several cases of heart disease,
senile gangrene and one of cor villosum. From no other book do we
get so good an idea of a practitioner's experience at this period; the
notes are plain and straightforward, and singularly free from all
theoretical and therapeutic vagaries. He gives several remarkable
instances of faith healing and, case No. 26, a man with the point of
an arrow sticking in his left scapula.

To know accurately the anatomical changes that take place in
disease is of importance both for diagnosis and for treatment. The
man who created the science, who taught us to think anatomically of
disease, was Morgagni, whose "De sedibus et causis morborum per
anatomen indagatis"* is one of the great books in our literature.
During the seventeenth century, the practice of making post-mortem
examinations had extended greatly, and in the "Sepulchretum ana-
tomicum" of Bonetus (1679) , these scattered fragments are collected.'
But the work of Morgagni is of a different type, for in it are the
clinical and anatomical observations of an able physician during a long
and active life. The work had an interesting origin. A young friend
interested in science and in medicine was fond of discoursing with
Morgagni about his preceptors, particularly Valsalva and Albertini,
and sometimes the young man inquired about Morgagni's own obser-

3 Possibly it was only a case of angina Ludovici, or retro-pharyngeal abscess.
* Venice, 1761.

5 Boerhaave remarked that if a man wished to deserve or get a medical degree from one
medical author let it be this. (James Atkinson: Medical Bibliography, 1834, 268.)

186 THE EVOLUTION OF MODERN MEDICINE

vations and thoughts^ Yielding to a strong wish, Morgagni con-
sented to write his young friend famihar letters describing his experi-
ences. I am sorry that Morgagni does' not mention the name of the
man to whom we are so much indebted, and who, he states, was so

FIG. 86.
Giovanni Battista Morgagni.

pleased with the letters that he continually solicited him to send more
and more "till he drew me on so far as the seventieth; . . . when I
begged them of him in order to revise their contents ; he did not return
them, till he had made me solemnly promise, that I would not abridge
any part thereof " (Preface).

Born in 1682, Morgagni studied at Bologna under Valsalva and

JO. BAPTISTS

MORGAGNJ

P.

P. P.

DE SEDIBUS, ET CAUSIS

MO R B O R U M

PER ANATOMEN INDAGATIS

_L I B K 1 , ^ U i N J^ U E.

DISS^CTIONES, ET ANIMADVERSIONfiS, NUNC PRIMUM EOITAS

COMPLECTUNTUR PROPEMODUM INNUMERAS, MEDICIS,

CHIRURGIS, ANATOMICIS PROFUTURAS.

Multiplex praefixus eft Index rerum,& nommum
accuraciflimus .
TO MUS PR IMUS

DUOS PRIORES CONTINENS L I B R O S.

Si-MJ'i' ^'^'

j2. ^a/'L/cxJi/-'y*t^

,c^^

V E N E T I I S,

M D C C L X I.

^- ~ , £x TyPOSKAPHIA R.BMONDIWIAM4.

SVPBt.lO'K'y M PE-^MISSV, AC P B^l V 1 L E G 1 0,

FIG. 87.
Title-page of Morgagni's De Sedibus (1761).

188 THE EVOLUTION OF MODERN MEDICINE

Albertini. In 1711, he was elected professor of medicine at Padua.
He published numerous anatomical observations and several smaller
works of less importance. The great work which has made his name
immortal in the profession, appeared in his eightieth year, and repre-
sents the accumulated experience of a long life. Though written in
the form of letters, the work is arranged systematically and has an
index of exceptional value'. From no section does one get a better idea
of the character and scope of the work than from that relating to the
X heart and arteries — affections of the pericardium, diseases of the
valves-, ulceration, rupture, dilation and hypertrophy and affections of
the aorta are very fully described. The section on aneurysm of the
aorta remains one of the best ever written. It is not the anatomical
observations alone that make the work of unusual value, but the com-
bination of clinical with anatomical records. What could be more
correct than this account of angina pectoris — probably the first in the
literature? "A lady forty- two years of age, who for a long time, had
been a valetudinarian, and within the same period, on using pretty
quick exercise of body, she was subject to attacks of violent anguish
in the upper part of the chest on the left side, accompanied with a
difficulty of breathing, and numbness of the left arm; but these
paroxysms soon subsided when she ceased from exertion. In these
circumstances, but with cheerfulness of mind, she undertook a journey
from Venice, purposing to travel along the continent, when she was
seized with a paroxysm, and died on the spot. I examined the body on
the following day. . . . The aorta was considerably dilated at its
curvature; and, in places, through its whole tract, the inner surface
was unequal and ossified. These appearances were propagated into
the arteria innominata. The aortic valves were indurated. ..."
He remarks, "The delay of blood in the aorta, in the heart, in the
pulmonary vessels, and in the vena cava, would occasion the symptoms
of which the woman complained during life; namely, the violent
uneasiness, the difficulty of breathing, and the numbness of the arm."*
Morgagni's life had as much influence as his work. In close corre-
spondence with the leading men of the day, with the young and rising

6 Cooke's Morgagnl, Vol. I, pp. 417-418. I cannot too warmly commend to young clini-
cians the reading of Morgagni. English editions are available — Alexander's three-volume
translation of 1769 and Cooke's Abridgement (London, 1822), of which there was an American
edition published in Boston in 1824.

DEVELOPMENT OF MODERN MEDICINE 189

teachers and workers, his methods must ha,ve been a great inspiration;
and he came just at the right time. The profession was literally
ravaged by theories, schools and. systems — iatromechanics, iatro-
chemistry, humoralism, the animism of Stahl, the vitalistic doctrines of
Van Helmont and his followers — and into this metaphysical confusion
Morgagni came like an old Greek with his clear observation, sensible
thinking and ripe scholarship. Sprengel well remarks that "it is hard

FIG. 88.
Thomas Sydenham.

to say whether one should admire most his rare dexterity and quickness
in dissection, his unimpeachable love of truth and justice in his estima-
tion of the work of others, his extensive scholarship and rich classical
style or his downright common sense and manly speech."

Upon this solid foundation the morbid anatomy of modern clinical
medicine was built. Many of Morgagni's conternporaries did not
fully appreciate the change that was in progress, and the value of the
new method of correlating the clinical symptoms and the morbid
appearances. After all, it was only the extension of the Hippocratic

190 THE EVOLUTION OF MODERN MEDICINE

method of careful observation — the study of facts from which reason-
able conclusions could be drawn. In every generation there had been
men of this type — I dare say many more than we realize — men of the
Benivieni character, thoroughly practical, clear-headed physicians.
A model of this sort arose in England in the middle of the seventeenth
century, Thomas Sydenham (1624-1689), who took men back to
Hippocrates, just as Harvey had led them back to Galen. Sydenham

n/ broke with authority and went to nature. It is extraordinary how he
could have been so emancipated from dogmas and theories of all sorts.
He laid down the fundamental proposition, and acted upon it, that
"all disease could be described as natural history." To do him justice
we must remember, as Dr. John Brown says, "in the midst of what a
mass of errors and prejudices, of theories actively mischievous, he was
placed, at a time when the mania of hypothesis was at its height, and
when the practical part of his art was overrun and stultified by vile and
silly nostrums" ("Horas Subsecivae," Vol. I, 4th ed., Edinburgh,
1882, p. 40).

Listen to what he says upon the method of the study of medicine :
"In writing therefore; such a natural history of diseases, every merely
philosophical hypothesis should be set aside, and the manifest and
natural phenomena, however minute, should be noted with the utmost
exactness. The usefulness of this procedure cannot be easily over-
rated, as compared with thd subtle inquiries and trifling notions of
modern writers, for can there be a shorter, or indeed any other way of
coming at the niorbific causes, or discovering the curative indications
than by a certain perception of the peculiar symptoms? By these
steps and helps it was that the father of physic, the great Hippocrates,
came to excel, his theory being no more than an exact description or
view of nature. He found that nature alone often terminates diseases,
and works a cure with a few simple medicines, and often enough with
no medicines at all."

Towards the end of the centurj^ many great clinical teachers arose,
of whom perhaps the most famous was Boerhaave, often spoken of

7^ as the Dutch Hippocrates, who inspired a group of distinguished
students. I have already referred to the fact that Franciscus Sylvius v
at Leyden was the first among the moderns to organize systematic
clinical teaching. Under Boerhaave, this was so developed that to this
Dutch university students flocked from all parts of Europe. After

DEVELOPMENT OF MODERN MEDICINE 191

teaching botany and chemistry, Boerhaave succeeded to the chair of
physic in 1714. With an unusually wide general training, a profound
knowledge of the chemistry of the day and an accurate acquaintance
with all aspects of the history of the profession, he had a strongly
objective attitude of mind towards disease, following closely the
methods of Hippocrates and Sydenham, He adopted no special
system, but studied disease as one of the phenomena of nature. His

.''■fc jci. '1 .e . a D Uinicc.'i 'yhc ni ' if ■ ^3

"' He / I I . ci > in \"AD I ■ - r a \r -/: \

7 i ■ 1.

J' { > > 1 > J li I D ^ ;i

FIG. 89.
Hermann Boerhaave.

llli'L m\\\\\\\\\k*'M^f»'M\M'

FIG. 90.
Giovanni Maria Lancisi.

DEVELOPMENT OF MODERN MEDICINE 193

clinical lectures, held bi-weekly, became exceedingly popular and
were made attractive not less by the accuracy and care with which the
cases were studied than by the freedom from fanciful doctrines and
the frank honesty of the man. He was much greater than his pub-
lished work would indicate, and, as is the case with many teachers of
the first rank, his greatest contributions were his pupils. No other
teacher of modern times has had such a following. Among his

1^

X3

W9%

^Ptj'Y /yJB

^^

mm

^1 ..

■:^^1^^

m.

FW>fl

^^^^

^^'■

W .^''-^

-'■2^'%

s.

r

Au..Z.. l'Mar^ji.,,„J'.',Ki„ 'l4^.

^

FIG. 91.
Giorgio Baglivi.

favorite pupils may be mentioned Haller, the physiologist, and van
Swieten and de Haen, the founders of the Vienna school.

In Italy, too, there were men who caught the new spirit, and appre-
ciated the value of combining morbid anatomy with clinical medicine.
Lancisi, one of the early students of disease of the heart, left an
excellent monograph on the subject, and was the first to call special
attention to the association of syphilis with cardio-vascular disease.
A younger contemporary of his at Rome, Baglivi, was unceasing in

\

194 THE EVOLUTION OF MODERN MEDICINE

his call to the profession to return to Hippocratic methods, to stop
reading philosophical theories and to give up what he calls the "fatal
itch" to make systems.

The Leyden methods of instruction were carried far and wide

FIG. 92.
William Cullen.

throughout Europe; into Edinburgh by John Rutherford, who began
to teach at the Royal Infirmary in 1747, and was followed by Whytt
and by Cullen; into England by William Saunders of Guy's Hospital.
Unfortunately the great majority of clinicians could not get away
from the theoretical conceptions of disease, and CuUen's theory of

DEVELOPMENT OF MODERN MEDICINE 195

spasm and atony exercised a profound influence on practice, par-
ticularly in this country, where it had the warm advocacy of Benjamin
Rush. Even more widespread became the theories of a pupil of
CuUen's, John Brown, who regarded excitability as the fundamental
property of all living creatures : too much of this excitability produced
what were known as sthenic maladies, too little, asthenic; on which
principles practice was plain enough. Few systems of medicine have
ever stirred such bitter controversy, particularly on the Continent,
and in Charles Creighton's account of Brown' we read that as late

7 Dictionary of National Biography, London, 1886, VII, 14i-17.

FIG. 93.
Benjamin Rush.

196 THE EVOLUTION OF MODERN MEDICINE

as 1802 the University of Gottingen was so convulsed by controversies
as to the merits of the Brunonian system that contending factions of
students in enormous numbers, not unaided by the professors, met in

FIG. 94.
John Brown.

combat in the streets on two consecutive days and had to be dispersed
by a troop of Hanoverian horse.

But the man who combined the quahties of Vesahus, Harvey and
Morgagni in an extraordinary personahty was John Hunter. He
wais, in the first place, a naturalistto whom pathological processes were
only a small part of a stupendous whole, governed by law, which,

DEVELOPMENT OF MODERN MEDICINE 197

however, could never be understood until the facts had been accu-
mulated, tabulated and systematized. By his example, by his pro-
digious industry, and by his suggestive experiments he led men again
into the old paths of Aristotle, Galen and Harvey. He made all

FIG. 95.
John Hunter.

thinking physicians naturalists, and he lent a dignity to the study of
organic life, and re-established a close union between medicine and the
natural sciences. Both in Britain and Greater Britain, he laid the
foundation of the great collections and museums, particularly those
connected with the medical schools. The Wistar-Horner and the
Warren Museums in this country originated with men greatly influ-

A'

198 THE EVOLUTION OF MODERN MEDICINE

enced by Hunter. He was, moreover, the intellectual father of that
interesting group of men on this side of the Atlantic who, while prac-
tising as physicians, devoted much time and labor to the study of
natural history; such men as Benjamin Smith Barton, David Hos-
sack, Jacob Bigelow, Richard Harlan, John D. Godman, Samuel
George Morton, John Collins Warren, Samuel L. Mitchill and
J. Aitken Meigs. He gave an immense impetus in Great Britain to
the study of morbid anatomy, and his nephew, Matthew Baillie, pub-
lished the first important book on the subject in the English language.
Before the eighteenth century closed practical medicine had made
great advance. Smallpox, though not one of the great scourges like
plague or cholera, was a prevalent and much dreaded disease, and in
civilized countries few reached adult life without an attack. Edward
Jenner, a practitioner in Gloucestershire, and the pupil to whom John

FIG. 96.
Edward Jenner.

DEVELOPMENT OF MODERN MEDICINE 199

Hunter gave the famous advice: "Don't think, try!" had noticed that
millonaids who had been infected with cowpox from the udder of the
cow were insusceptible to smallpox. I show you here (Fig. 97)
the hand of Sarah Nelmes with cowpox, 1796. A vague notion had
prevailed among the dairies from time immemorial that this disease
was a preventive of the smallpox. Jenner put the matter to the test
of experiment. Let me quote here his own words : "The first experi-
ment was made upon a lad of the name of Phipps, in whose arm a little

FIG. 97.

Hand of Sarah Nelmes, inoculalted with cowpox.

{From Jenner'' s Inquiry?)

vaccine virus was inserted, taken from the hand of a young woman
who had been accidentally infected by a cow. Notwithstanding the
resemblance which the pustule, thus excited on the boy's arm, bore to
variolous inoculation, yet as the indisposition attending it was barely
perceptible, I could scarcely persuade myself the patient was secure
from the Small Pox. However, on his being inoculated some months
afterwards, it proved that he was secure."* The results of his experi-
ments were published in a famous small quarto volume in 1798. (Fig.
98.)* From this date, smallpox has been under control. Thanks to
Jenner, not a single person in this audience is pockmarked ! A
hundred and twenty-five years ago, the faces of more than half of you
would have been scarred. We now know the principle upon which
protection is secured : an active acquired immunity follows upon an
attack of a disease of a similar nature. Smallpox and cowpox are
closely allied and the substances formed in the blood by the one are

s Edward Jenner: The Origin of the Vaccine Inoculation, London, 1801.

* Reprinted by Camac: Epoch-making Contributions to Medicine, etc., 1909. — Ed.

200 THE EVOLUTION OF MODERN MEDICINE

IJ^aUJRY

THE CAUSES AND EFFECTS

THE VARIOLiE VACCIK^,
■A DISEASE

DISCOVERED IS SOME OF TflE WEStBR^" COUNTIES OF KNCLAND,

GLOUCESTERSHIRE.

THE COW POX. .

BY ZDWARD*JENNER, M.D. K.R.S, if.

resistant to the virus of the other. I do not see how any reasonable
person can oppose vaccination or decry its benefits. I show you (Figs.
99, 100) the mortahty figures" of the Prussian Army and of the Ger-
man Empire. A comparison with the statistics of the armies of other
European countries in which revaccination is not so thoroughly carried
out is most convincing of its efficacy.

The early years of the century saw the rise of modern clinical medi- \^

cine in Paris. In the art of obser-
vation men had come to a stand-
still. I doubt very much whether
Corvisart in 1800 was any more
skilful in recognizing a case of
pneumonia than was Areteeus in
the second century A. D. But
disease had come to be more sys-
tematically studied; special clin-
ics were organized, and teaching
became much more thorough.
Anyone who wishes to have a pic-
ture of the medical schools in
Europe in the first few years of
the century, should read the ac-
count of the travels of Joseph
Frank of Vienna.^" The descrip-
tion of Corvisart is of a pioneer in
clinical teaching whose method re-
mains in vogue today in France —
the ward visit, followed by a sys-
tematic lecture in the amphitheatre. There were still lectures on
Hippocrates three times a week, and bleeding was the principal plan
of treatment : one morning Frank saw thirty patients, out of one hun-
dred and twelve, bled! Corvisart was the strong clinician of his
generation, and his accurate studies on the heart were among the first
that had concentrated attention upon a special organ. To him, too, is
due the reintroduction of the art of percussion in internal disease
V" discovered by Auenbrugger in 1761.

9 Jockmann: Pocken und Vaccinationlehre, 1913.

10 Joseph Frank: Reise nach Paris [etc.], Wlen, 1804-05.

FIG. 98.
Title-page of Jenner's Inquiry.

DEVELOPMENT OF MODERN MEDICINE 201

The man who gave the greatest impetus to the study of scientific
medicine at this time was Bichat, who pointed out that the pathological
changes in disease were not so much in organs as in tissues. His
studies laid the foundation of modern histology. He separated the
chief constituent elements of the body into various tissues possessing
definite physical and vital qualities. "Sensibility and contractability

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FIG. 99.

Chart giving effect of vaccination on smallpox

mortality in the German Army.

are the fundamental qualities of living matter and of the life of our
tissues. Thus Bichat substituted for vital forces vital properties,'
that is to say, a series of vital forces inherent in the different tissues.""
His "Anatomic Generale," published in 1802, gave an extraordinary
stimulus to the study of the finer processes of disease, and his famous
"Recherches sur la Vie et sur la Mort" (1800) dealt a deathblow to
old iatromechanical and iatrochemical views. His celebrated defini-
tion may be quoted: "La vie est I'ensemble des proprietes vitales qui
resistent aux proprietes physiques, ou bien la vie est I'ensemble des
fonctions qui resistent a la mort." (Life is the sum of the vital prop-

11 E. Boinet: Les doctrines m^dicales, leur Evolution, Paris, 190T, pp. 85-86.

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DEVELOPMENT OF MODERN MEDICINE 203

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erties that withstand the physical properties, or, hfe is the sum of the
functions that withstand death. ) Bichat is another pathetic figure in
medical history. His meteoric career ended in his thirty-first year: he
died a victim of a post-mortem wound infection. At his death, Corvi-

sart wrote Napoleon: "Bichat has
just died at the age of thirty. That
battlefield on which he fell is one
which demands courage and claims
many victims. He has advanced
the science of medicine. No one
at his age has done so much so
well."

It was a pupil of Corvisart, Rene
Theophile Laennec, who laid the
foundation of modern clinical medi-
cine. The story of his life is well
known. A Breton by birth, he had
a hard, up-hill struggle as a young
man — a struggle of which we have
only recently been made aware by
the publication of a charming book
by Professor Rouxeau of Nantes —
"Laennec avant 1806." Influenced
by Corvisart, he began to combine
the accurate study of cases in the wards with anatomical investigations
in the dead-house. Before Laennec, the examination of a patient had
been largely by sense of sight, supplemented by that of touch, as in
estimating the degree of fever, or the character of the pulse. Auen-
brugger's "Irwentum novum," of percussion, recognized by Corvisart,
extended the field; but the discovery of auscultation by Laennec, and
the publication of his work — "De I'Auscultation Mediate," 1819, —
marked an era in the study of medicine. The clinical recognition of
individual diseases had made really very little progress; with the
stethoscope begins the day of physical diagnosis. The clinical pathol-
ogy of the heart, lungs and abdomen was revolutionized. Laennec's
book is in the category of the eight or ten greatest contributions to
the science of medicine. (Fig. 102.) * His description of tuberculosis

*John Forbes's translation of Auenbrugger and part of his translation of Laennec are
reprinted in Caraac's Epoch-making Contributions, etc., 1909. — Ed.

FIG. 101.
Auenbrugger.

204 THE EVOLUTION OF MODERN MEDICINE

DE

UAUSCULTATION

MEDIATE

TRAlTli DU niAU^OSTIC DES MALADIES
11K.S i'urMo?i.s ET i)U C0F:un,

FO\Ut; PKl^ClfAT,EMEXT SUR CE SOOVEAV
110VE\ D'F.Xri.ORATlO.X.

Pai. u. t. h. LAENNEC,

n ^1 p., M.:,I.TMi il.- lll.ij-ilBl ^.^k.■^, MiMrciii li.iliorairr

prindc lUTLiedcrarl. ILtrr., Eyul. It

TOME PREMIER.

is perhaps the most masterly chapter in dinical medicine. This revo-
lution was effected by a simple extension of the Hippocratic method
from the bed to the dead-house, and by correlating the signs and
symptoms of a disease with its anatomical appearances.

The pupils and successors of Corvisart — Bayle, Andral, Bouillaud,

Chomel, Piorry, Bretonneau, Rayer,
Cruveilhier and Trousseau —
brought a new spirit into the profes-
sion. Everywhere the investigation
of disease by clinical-pathological
methods widened enormously the
diagnostic powers of the physician.
By this method Richard Bright, in
1836, opened a new chapter on the
relation of disease of the kidney to
dropsy, and to albuminous urine.
It had already been shown by Black-
well and by Wells, the celebrated
Charleston (S. C.) physician, in
1811, that the urine contained al-
bumin in many cases of dropsy, but
it was not until Bright began a care-
ful investigation of the bodies of
patients who had presented these
symptoms, that he discovered the
association of various forms of dis-
ease of the kidney with anasarca
and albuminous urine. In no direc-
tion was the harvest of this combined
study more abundant than in the
complicated and confused subject of fever. The work of Louis and
of his pupils, W. W. Gerhard and others, revealed the distinction be-
tween typhus and typhoid fever, and so cleared up one of the most
obscure problems in pathology. By Morgagni's method of "anatomi-
cal thinking," Skoda in Vienna, Schonlein in Berlin, Graves and
Stokes in Dublin, Marshall Hall, C. J. B. Williams and many others
introduced the new and exact methods of the French and created a
new clinical medicine. A very strong impetus was given by the re-

A PAIUS,

-A. BROSNOX t

-.S. C:i \LDK, J.iLr.iiri

FIG. 1U2.

Title-page of Laennec's Treatise
on Mediate Auscultation (l8I9).

DEVELOPMENT OF MODERN MEDICINE 205

searches of Virchow on cellular pathology, which removed the seats of
disease from the tissues, as taught by Bichat, to the individual ele-
ments, the cells. The introduction of the use of the microscope in
clinical work widened greatly our powers of diagnosis, and we ob-
tained thereby a very much clearer conception of the actual processes

FIG. JOS.
Statue of Laennec.

206 THE EVOLUTION OF MODERN MEDICINE

of disease. In another way, too, medieine was greatly helped by the
rise of experimental pathology, which had been introduced by John
'^ Hunter, was carried along by Magendie and others, and reached its
culmination in the epoch-making researches of Claude Bernard. Not
only were valuable studies made on the action of drugs, but also our
knowledge of cardiac pathology was revolutionized by the work of
Traube, Cohnheim and others. In no direction did the experimental
method effect such a revolution as in our knowledge of the functions of
the brain. Clinical neurology, which had received a great impetus by
the studies of Todd, Romberg, I^ocldiart Clarke, Duchenne and Weir
Mitchell, was completely revolutionized by the experimental work of
Hitzig, Fritsch and Ferrier on the localization of functions in the
brain. Under Charcot, the school of French neurologists gave great
accuracy to the diagnosis of obscure affections of the brain and spinal
cord, and the combined results of the new anatomical, physiological
and experimental work have rendered clear and definite what was
formerly the most obscure and complicated section of internal medi-
cine. The end of the fifth decade of the century is marked by a dis-
covery of supreme importance. Humphry Davy had noted the
effects of nitrous oxide. The exhilarating influence of sulphuric ether
had been casually studied, and Long of Georgia had made patients
inhale the vapor until anaesthetic and had performed operations upon
them when in this state; but it was not until October 16, 1846, in the
,Massachusetts General Hospital, that Morton, in a public operating
room, rendered a patient insensible with ether and demonstrated the
utility of surgical anaesthesia. The rival claims of priority no longer
interest us, but the occasion is one of the most memorable in the history
of the race. It is well that our colleagues celebrate Ether Day in
Boston — no more precious boon has ever been granted to suffering
humanity.*

In 1857, a young man, Louis Pasteur, sent to the Lille Scientific
Society a paper on "Lactic Acid Fermentation" and in December
of the same year presented to the Academy of Sciences in Paris a
paper on "Alcoholic Fermentation" in which he concluded that "the
deduplication of sugar into alcohol and carbonic acid is correlative to

*Cf. Osier: Proc. Roy. Soc. Med., XI, Sect. Hist. Med., pp. 65-69, 1918, or, Annals Med.
Hist., N. Y., I, 329-332. Cf. also Morton's publications reprinted in Camac's book cited above
—Ed.

FIG. 104.
Louis Pasteur.

-JSE

.V

208 THE EVOLUTION OF MODERN MEDICINE

a phenomenon of life." A new era in medicine dates from those two
publications. The story of Pasteur's life should be read by every
student.* It is one of the glories of human literature, and, as a record
of achievement of nobility of character, is almost without an equal.

At the middle of the last century we did not know much more of
the actual causes of the great scourges of the race, the plagues, the
fevers and the pestilences, than did the Greeks. Here comes Pasteur's
great work. Before him Egyptian darkness ; with his advent a light
that brightens more and more as the years give us ever fuller knowl-
edge.* The facts that fevers were catching, that epidemics spread,
that infection could remain attached to articles of clothing, etc., all
gave support to the view that the actual cause was something alive, a
contagium vivum. It was really a very old view, the germs of which
may be found in the Fathers, but which was first clearly expressed —
so far as I know — by Fracastorius, the Veronese physician, in the
sixteenth century, who spoke of the seeds of contagion passing from
one person to another ;^^ and he first drew a parallel between the
'' processes of contagion and the fermentation of wine. This was more
than one hundred years before Kircher, tifeeuwenhoek and others
began to use the microscope and to see animalculse, etc., in water, and
so give a basis for the "infinitely little" view of the nature of disease
germs. And it was a study of the processes of fermentation that led
Pasteur to the sure ground on which we now stand.

Out of these researches arose a famous battle which kept Pasteur
hard at work for four or five years — the struggle over spontaneous
generation. It was an old warfare, but the microscope had revealed a
new world, and the experiments on fermentation had lent great weight
to the omne vivum ex ovo doctrine. The famous Italians, Redi and
Spallanzani, had led the way in their experiments, and the latter had
reached the conclusion that there is no vegetable and no animal that
has not its own germ. But heterogenesis became the burning question,
and Pouchet in France, and Bastian in England, led the opposition to
Pasteur. The many famous experiments carried conviction to the
minds of scientific men, and destroyed forever the old belief in spon-
taneous generation. All along, the analogy between disease and fer-

* Osier wrote a preface for the 1911 English edition of the Life by VaUery-Radot. — Ed.
i2Varro, in De Re Rustica, Bk. I, 12 (circa 40 B. C), speaks of minute organisms which
the eye cannot see and which enter the body and cause disease.

DEVELOPMENT OF MODERN MEDICINE 209

mentation must have been in Pasteur's mind; and then came the sug-
gestion, "What would be most desirable is to push those studies far
enough to prepare the road for a serious research into the origin of
various diseases." If the changes, in lactic, alcoholic and butyric fer-
mentations are due to minute living organisms, why should not the
same tiny creatures make the changes which occur in the body in the
putrid and suppurative diseases? With an accurate training as a
chemist, having been diverted in his studies upon fermentation into
the realm of biology, and nourishing a strong conviction of the identity
between putrefactive changes of the body and fermentation, Pasteur
was well prepared to undertake investigations which had hitherto
been confined to physicians alone.

So impressed was he with the analogy between fermentation and
the infectious diseases that, in 1863, he assured the French Emperor
of his ambition "to arrive at the knowledge of the causes of putrid and
contagious diseases." After a study upon the diseases of wines, which
has had most important practical bearings, an opportunity arose which
changed the whole course of his career, and profoundly influenced the
development of medical science. A disease of the silkworm had, for
some years, ruined one of the most important industries in France, and
in 1865 the Government asked Pasteur to give up his laboratory work
and teaching, and to devote his whole energies to the task of investi-
gating it. The story of the brilliant success which followed years of
application to the problem will be read with deep interest by every
student of science. It was the first of his victories in the application
of the experimental methods of a trained chemist to the problems of
biology, and it placed his name high in the group of the most illus-
trious benefactors of practical industries.

In a series of studies on the diseases of beer, and on the mode of
production of vinegar, he became more and more convinced that these
studies on fermentation had given him the key to the nature of the
infectious diseases. It is a remarkable fact that the distinguished
English philosopher of the seventeenth century, the man who more
than anyone else of his century appreciated the importance of the
experimental method, Robert Boyle, had said that he who could
discover the nature of ferments and fermentation, would be more
capable than anyone else of explaining the nature of certain diseases.

In 1876 there appeared in Cohn's "Beitrage zur Morphologic der

FIG. 105.
Robert Koch.

DEVELOPMENT OF MODERN MEDICINE 211

Pflanzen" (II, 277-310) , a paper on the "^Etiology of Anthrax" by a
German district' physician in WoUstein, Robert Koch (Fig/ 105),
which is memorable in our Hterature as the starting point of a new
method of research into the causation of infectious diseases. Koch
demonstrated the constant presence of germs in the blood of animals

Untersuchungen

Aetiologie

WuiK iiifectioiiskranklieiteii

Dr. Robert Koili. '

.M;i -. VaHii AblilJ.iiiy"Lt,

'. Loilizig,

Vfilii,; i-.jii y. 0. W, Vcjcl.

FIG. 106.

Title-page of Koch's monograph on
wound infection (with autograph

of Lister, 1878).

dying from the disease. Years before, those organisms had been seen
by PoUender and Davaine, but the epoch-making a,dvance of Koch
was to grow those organisms in a pure culture outside the body, and
to produce the disease artificially by inoculating animals with the
cultures. Koch is really our medical Galileo, who, by means of a new
technique, — pure cultures and isolated staining, — introduced us to a

L

212 THE EVOLUTION OF MODERN MEDICINE

'new world. In 1878, followed his study on the "Etiology of Wound
Infections," in which he was able to demonstrate conclusively the asso-
ciation of micro-organisms with the disease. (Fig. 106.) Upon those
two memorable researches made by a country doctor rests the modern
science of bacteriology.

The next great advance was the discovery by Pasteur of the possi-
bility of so attenuating, or weakening, the poison that an animal
inoculated had a slight attack, recovered and was then protected
against the disease. More than eighty years had passed since on May
14, 17^96, Jenner had vaccinated a child with cowpox and proved that
a slight attack of one disease protected the body from a disease of an
allied nature. An occasion equally famous in the history of medicine
was a day in 1881, when Pasteur determined that a flock of sheep
vaccinated with the attenuated virus of anthrax remained well, when
every one of the unvaccinated infected from the same material had
died. Meanwhile, from Pasteur's researches on fermentation and

7 spontaneous generation, a transformation had been initiated in the
practice of surgery, which, it is not too much to say, has proved one of
the greatest boons ever conferred upon humanity. It had long been
recognized that, now and again, a wound healed without the formation
of pus, that is, without suppuration, but both spontaneous and opera-
tive wounds were almost invariably associated with that process ; and,
moreover, they frequently became putrid, as it was then called, —
infected, as we should say, — the general system became involved and
the patient died of blood poisoning. So common was this, particularly
in old, ill-equipped hospitals, that many surgeons feared to operate,
and the general mortality in all surgical cases was very high. Believ-
ing that it was from outside that the germs came which caused the de-
composition of wounds, just as from the atmosphere the sugar solu-
tion got the germs which caused the fermentation, a young surgeon
in Glasgow, Joseph Lister, applied the principles of Pasteur's experi-

/ ments to their treatment. From Lister's original paper* I quote the
following: "Turning now to the question how the atmosphere pro-
duces decomposition of organic substances, we find that a flood of
light has been thrown upon this most important subject by the philo-
sophic researches of M. Pasteur, who has demonstrated by thoroughly
convincing evidence that it is not to its oxygen or to any of its gaseous

* Lancet, March 16, 1867. [Cf. Camac: Epoch-making Contributions, etc., 1909, p. 7.— Ed.]

FIG. 107.
Lord Lister.

214 THE EVOLUTION OF MODERN MEDICINE

constituents that the air owes this property, but to minute particles
suspended in it, which are the germs of various low forms of life, long
since revealed by the microscope, and regarded as merely accidental
concomitants of putrescence, but now shown by Pasteur to be its essen-
tial cause, resolving the complex organic compounds into substances
of simpler chemical constitution, just as the yeast-plant converts
sugar into alcohol and carbonic acid." From these beginnings modern
surgery took its rise, and the whole subject of wound infection, not
only in relation to surgical diseases, but to child-bed fever, forms now
one of the most brilliant chapters in the history of preventive medicine.

With the new technique and experimental methods, the discovery
of the specific germs of many of the more important acute infections
followed each other with bewildering rapidity: typhoid fever, diph-
theria, cholera, tetanus, plague, pneumonia, gonorrhoea and, most
important of all, tuberculosis. It is not too much to say that the
demonstration by Koch of the "bacillus tuberculosis" (1882) is, in its
far-reaching results, one of the most momentous discoveries ever made.

Of almost equal value have been the researches upon the protozoan
forms of animal life, as causes of disease. As early as 1873, spirilla
were demonstrated in relapsing fever. Laveran proved the associa-
tion of hsematozoa with malaria in 1880. In the same year, Griffith
Evans discovered trypanosomes in a disease of horses and cattle in
India, and the same type of parasite was found in the sleeping sick-
ness. Amoeba were demonstrated in one form of dysentery, and
in other tropical diseases protozoa were discovered, so that we were
, really prepared for the announcement in 1905, by Schaudinn, of the
discovery of a protozoan parasite in syphilis. Just fifty years had
passed since Pasteur had sent in his paper on "Lactic Acid Fermenta-
tion" to the Lille Scientific Society — half a century in which more had
been done to determine the true nature of disease than in all the time
that had passed since Hippocrates. Celsus makes the oft-quoted re-
mark that to determine the cause of a disease often leads to the
remedy,* and it is the possibility of removing the cause that gives such
importance to the new researches on disease.

* "Et causae quoque estimatio ssepe morbum solvit," Celsus, Lib. I, Prefatio. — Ed.

INTERNAL SECRETIONS 215

INTERiVAL SECRETIONS

One of the greatest contributions of the nineteenth century to scien-
tific medicine was the discovery of the internal secretions of organs.
The basic work on the subject was done by Claude Bernard, a pupil
of the great Magendie, whose saying it is well to remember— "When \
entering a laboratory one should leave theories in the cloakroom."
More than any other man of his generation, Claude Bernard appre-
ciated the importance of experiment in practical medicine. For him
the experimental physician was the physician of the future — a view
well borne out by the influence his epoch-making work has had on
the treatment of disease. His studies on the glycogenic functions
of the liver opened the way for the modern fruitful researches on the
internal secretions of the various glands. About the same time that
Bernard was developing the laboratory side of the problem, Addison,
a physician to Guy's Hospital, in 1855, pointed out the relation of a
remarkable group of symptoms to disease of the suprarenal glands,
small bodies situated above the kidneys, the importance of which had
not been previously recognized. With the loss of the function of
these glands by disease, the body was deprived of something formed
bj^ them which was essential to its proper working. Then, in the last
third of the century, came in rapid succession the demonstration of
the relations of the pancreas to diabetes, of the vital importance of
the thyroid gland and of the pituitary body. Perhaps no more strik-
ing illustration of the value of experimental medicine has ever been
given than that afforded by the studies upon those glands.

The thyroid body, situated in the neck and the enlargement of
which is called goitre, secretes substances which pass into the blood,
and which are necessary for the growth of the body in childhood, for
the development of the mind and for the nutrition of the tissues of
the skin. If, following an infectious disease, a child has wasting of
this gland, or if, living in a certain district, it has a large goitre, normal
development does not take place, and the child does not grow in mind
or body and becomes what is called a cretin. More than this — if in
adult life the gland is completely removed, or if it wastes, a somewhat
similar condition is produced, and the patient in time loses his mental
powers and becomes fat and flabby — myxedematous. It has been
shown experimentally in various ways that the necessary elements of

216 THE EVOLUTION OF MODERN MEDICINE

the secretion can be furnished by feeding with the gland or its extracts,
and that the cretinoid or myxedematous conditions could thus be
cured or prevented.

Experimental work has also demonstrated the functions of the
suprarenal glands and explained the symptoms of Addison's disease,
and chemists have even succeeded in making synthetically the active
principle adrenalin.

There is perhaps no more fascinating story in the history of science
than that of the discovery of these so-called ductless glands. Part of
its special interest is due to the fact that clinicians, surgeons, experi-
mental physiologists, pathologists and chemists have all combined in
splendid teamwork to win the victory. No such miracles have ever
before been wrought by physicians as those which we see in connection
with the internal secretion of the thyroid gland. The myth of bringing
the dead back to life has been associated with the names of many great
healers since the incident of Empedocles and Pantheia, but nowa-
days the dead in mind and the deformed in body may be restored by
the touch of the magic wand of science. The study of the interaction
of these internal secretions, their influence upon development, upon
mental process and upon disorders of metabolism is likely to prove in
the future of a benefit scarcely less remarkable than that which we
have traced in the infectious diseases.

CHEMISTRY

It is not making too strong a statement to say that the chemistry
and chemical physics of the nineteenth centur}^ have revolutionized
the world. It is difficult to realize that Liebig's famous Giessen
laboratory, the first to be opened to students for practical study,
was founded in the year 1825. Boyle, Cavendish, Priestley, La-
voisier, Black, Dalton and others had laid a broad foundation, and
Young, Frauenhofer, Rumford, Davy, Joule, Faraday, Clerk-Max-
well, Helmholtz and others built upon that and gave us the new
physics and made possible our age of electricity. New technique and
new methods have given a powerful stimulus to the study of the
chemical changes that take place in the body, which, only a few years
ago, were matters largely of speculation. "Now," in the words of
Professor Lee, "we recognize that, with its living and its non-living

CHEMISTRY 217

substances inextricably intermingled, the body constitutes an intensive
chemical laboratory in which there is ever occurring a vast congeries
of chemical reactions; both constructive and destructive processes go
on; new^ protoplasm takes the place of old. We can analyze the
income of the body, and we can analyze its output, and from these
data we can learn much concerning the body's chemistry. A great
improvement in the method of such work has recently been secured by
the device of enclosing the person who is the subject of the experiment
in a respiration calorimeter. This is an air-tight chamber, artificially
supplied with a constant stream of pure air, and from which the
expired air, laden with the products of respiration, is withdrawn for
purposes of analysis. The subject may remain in the chamber for
days, the composition of all food and all excreta being determined,
and all heat that is given off being measured. Favorable conditions
are thus established for an exact study of many problems of nutrition.
The difficulties increase when we attempt to trace the successive steps
in the corporeal pathway of molecule and atom. Yet these secrets of
the vital process are also gradually being revealed. When we remem-
ber that it is in this very field of nutrition that there exist great
popular ignorance and a special proneness to fad and prejudice, we
realize how practically helpful are such exact studies of metabolism."^^

13 Frederick S. Lee, Ph.D.: Scientific Features of Modern Medicine, New York, 1911. 1
would like to call attention to this work of Professor Lee's as presenting all the scientific
features of modern medicine in a way admirably adapted for anyone, lay or medical, who
wishes to get a clear sketch of them.

CHAPTER VI
THE RISE OF PREVENTIVE MEDICINE

THE story so far has been of men and of movements — of men
who have, consciously or unconsciously, initiated great move-
ments, and of movements by which, nolens volens, the men of
the time were moulded and controlled. Hippocrates, in the tractate
on "Ancient Medicine," has a splendid paragraph on the attitude of
mind towards the men of the past. My attention was called to it one
day in the Roman Forum by Commendatore Boni, who quoted it as
one of the great sayings of antiquity. Here it is: "But on that ac-
count, I say, we ought not to reject the ancient Art, as if it were not,
and had not been properly founded, because it did not attain accuracy
in all things, but rather, since it is capable of reaching to the greatest
exactitude by reasoning, to receive it and admire its discoveries, made
from a state of great ignorance, and as having been well and properly
made, and not from chance."^

I have tried to tell you what the best of these men in successive ages
knew, to show you their point of outlook on the things that interest
us. To understand the old writers one must see as they saw, feel as
they felt, believe as they believed — and this is hard, indeed impossible !
We may get near them by asking the Spirit of the Age in which they
lived to enter in and dwell with us, but it does not always come. Liter-
ary criticism is not literary history — we have no use here for the
former, but to analyze his writings is to get as far as we can behind
the doors of a man's mind, to know and appraise his knowledge, not
from our standpoint, but from that of his contemporaries, his prede-
cessors and his immediate successors. Each generation has its own
problems to face, looks at truth from a special focus and does not see
quite the same outlines as any other. For example, men of the present

iThe Works of Hippocrates, Adams, Vol. I, p. 168, London, 1849 (Sydenham Society).

THE RISE OF PREVENTIVE MEDICINE 219

generation grow up under influences very different from those which
surrounded my generation in the seventies of the last century, when
Virchow and his great contemporaries laid the sure and deep founda-
tions of modern pathology. Which of you now knows the "Cellular
Pathology" as we did? To many of you it is a closed book, — ^to many
more Virchow may be thought a spent force. But no, he has only
taken his place in a great galaxy. We do not forget the magnitude
of his labors, but a new generation has new problems — his message
was not for you — but that medicine today runs in larger moulds and
turns out finer castings is due to his life and work. It is one of the
values of lectures on the history of medicine to keep alive the good
influences of great men even after their positive teaching is antiquated.
Let no man be so foolish as to think that he has exhausted any subject
for his generation. Virchow was not happy when he saw the young
men pour into the old bottle of cellular pathology the new wine of
bacteriology. Lister could never understand how aseptic surgery
arose out of his work. Ehrlich would not recognize his epoch-making
views on immunity when this generation has finished with them. I be-
lieve it was Hegel who said that progress is a series of negations —
the denial today of what was accepted yesterday, the contradiction by
each generation of some part at least of the philosophy of the last;
but all is not lost, the germ plasm remains, a nucleus of truth to be
fertilized by men often ignorant even of the body from which it has
come. Knowledge evolves, but in such a way that its possessors are
never in sure possession. "It is because science is sure of nothing that
it is always advancing" (Duclaux) .

History is the biography of the mind of man, and its educational
value is in direct proportion to the completeness of our study of the
individuals through whom this mind has been manifested. I have
tried to take you back to the beginnings of science, and to trace its
gradual development, which is conditioned by three laws. In the first/
place, Hke a living organism, truth grows, and its gradual evolution
may be traced from the tiny germ to the mature product. Neverl
springing, Minerva-like, to full stature at once, truth may suffer allf
the hazards incident to generation and gestation. Much of history^
is a record of the mishaps of truths which have struggled to the birth, :
only to die or else to wither in premature decay. Or the germ may )
be dormant for centuries, awaiting the fullness of tim,e.

/

220 THE EVOLUTION OF MODERN MEDICINE

I Secondly, all scientific truth is conditioned by the state of knowl-
y( I edge at the time of its announcement. Thus, at the beginning of the
) seventeenth century, the science of optics and mechanical appliances
had not made possible (so far as the human mind was concerned) the
existence of blood capillaries and blood corpuscles. Jenner could not
have added to his "Inquiry" a study on immunity; Sir William Perkin
and the chemists made Koch technique possible; Pasteur gave the
conditions that produced Lister; Davy and others furnished the pre-
liminaries necessary for anaesthesia. Everywhere we find this filia-
tion, one event following the other in orderly sequence — "Mind begets
mind," as Harvey (De Generatione) says; "opinion is the source of
opinion. Democritus with his atoms and Eudoxus with his chief good,
which he placed in pleasure, impregnated Epicurus ; the four elements
of Empedocles, Aristotle; the doctrine of the ancient Thebans,
Pythagoras and Plato; Geometry, Euclid."^

And, thirdly, to scientific truth alone may the homo mensura prin-
ciple be applied, since of all mental treasures of the race it alone
compels general acquiescence. That this general acquiescence, this
aspect of certainty, is not reached per saltum, but is of slow, often of
difficult growth, — marked by failures and frailties, but crowned at last
with an acceptance accorded to no other product of mental activity, —
is illustrated by every important discovery from Copernicus to
Darwin.

The difficulty is to get men to the thinking level which compels the
application of scientific truths. Protagoras, that "mighty wise man,"
as Socrates called him, who was responsible for the aphorism that man
is the measure of all things, would have been the first to recognize the
follj"^ of this standard for the people at large. But we have gradually
reached a stage in which knowledge is translated into action, made
helpful for suffering humanity, just as the great discoveries in physics
and chemistry have been made useful in the advance of civilization.
We have traced medicine through a series of upward steps — a primi-
tive stage, in which it emerged from magic and religion into an
empirical art, as seen among the Egyptians and Babylonians ; a stage
in which the natural character of disease was recognized and the impor-
tance of its study as a phenomenon of nature was announced ; a stage
in which the structure and functions of the human body were worked.

2 Paraphrased from Harvey: Anatomical Exercitations [etc.], London, 1653, p. 550.

THE RISE OF PREVENTIVE MEDICINE 221

out ; a stage in which the chnical and anatomical features of disease I
were determined ; a stage in which the causes of disorders were profit- /
ably studied, and a final stage, into which we have just entered, the!
application of the knowledge for their prevention. Science has com-(
pletely changed man's attitude towards disease. *

Take a recent concrete illustration. A couple of years ago in
Philadelphia and in some other parts of the United States, a very
peculiar disease appeared, characterized by a rash upon the skin and
moderate fever, and a constitutional disturbance proportionate to the
extent and severity of the eruption. The malady first broke out in the
members of a crew of a private yacht ; then in the crews of other boats,
and among persons living in the boarding-houses along the docks.
It was the cause of a great deal of suffering and disability.

There were three courses open : to accept the disease as a visitation
of God, a chastening affliction sent from above, and to call to aid the
spiritual arm of the church. Except the "Peculiar People" few now
take this view or adopt this practice. The Christian Scientist would
probably deny the existence of the rash and of the fever, refuse to
recognize the itching and get himself into harmony with the Infinite.
Thirdly, the method of experimental medicine.

First, the conditions were studied under which the individual cases
occurred. The only common factor seemed to be certain straw mat-
tresses manufactured by four different firms, all of which obtained the
straw from the same source.

The second point was to determine the relation of the straw to the
rash. One of the investigators exposed a bare arm and shoulder for
an hour between two mattresses. Three people voluntarily slept on
the mattresses for one night. Siftings from the straw were applied
to the arm, under all of which circumstances the rash quickly de-
veloped, showing conclusively the relation of the straw to the disease.

Thirdly, siftings from the straw and mattresses which had been
thoroughly disinfected failed to produce the rash.

And fourthly, careful inspection of the siftings of the straw dis-
closed living parasites, small mites, which when applied to the skin
quickly produced the characteristic eruption.

222 THE EVOLUTION OF MODERN MEDICINE

SANITATION

When the thoughtful historian gets far enough away from the nine-
teenth century to see it as a whole, no single feature will stand out
with greater distinctness than the fulfilment of the prophecy of
Descartes that we could be freed from an infinity of maladies both
iof body and mind if we had sufficient knowledge of their causes and
I of all the remedies with which nature has provided us. Sanitation
takes its place among the great modern revolutions — political, social
i and intellectual. Great Britain deserves the credit for the first prac-
tical recognition of the maxim solus populi suprema lex. In the
middle and latter part of the century a remarkable group of men,
Southwood Smith, Chadwick, Budd, Murchison, Simon, Acland,
Buchanan, J. W. Russell and Benjamin Ward Richardson, put
practical sanitation on a scientific basis. Even before the full demon-
stration of the germ theory, they had grasped the conception that the
battle had to be fought against a living contagion which found in
poverty, filth and wretched homes the conditions for its existence.
One terrible disease was practically wiped out in twenty-five years of
(hard work. It is difficult to realize that within the memory of men
'now living, typhus fever was one of the great scourges of our large
cities, and broke out in terrible epidemics — ^the most fatal of all to the
jmedical profession. In the severe epidemic in Ireland in the forties
of the last century, one fifth of all the doctors in the island died of
typhus. A better idea of the new crusade, made possible by new
knowledge, is to be had from a consideration of certain diseases
against which the fight is in active progress.

Nothing illustrates more clearly the interdependence of the sciences
than the reciprocal impulse given to new researches in pathology and
entomology by the discovery of the part played by insects in the
transmission of disease. The flea, the louse, the bedbug, the house
fly, the mosquito, the tick, have all within a few years taken their
places as important transmitters of disease. The fly population may
be taken as the sanitarj?^ index of a place. The discovery, too, that
insects are porters of disease has led to a great extension of our knowl-
edge of their life history. Early in the nineties, when Dr. Thayer and
I were busy with the study of malaria in Baltimore, we began experi-
ments on the possible transmission of the parasites, and a tramp, who

SANITATION 223

had been a medical student, offered himself as a subject. Before we
began, Dr. Thayer sought information as to the varieties of mosqui-
toes known in America, but sought in vain : there had at that time been
no systematic study. The fundamental study which set us on the
track was a demonstration by Patrick Manson,^ in 1879, of the asso-
ciation of filarian disease with the mosquito. Many observations had
already been made, and were made subsequently, on the importance
of insects as intermediary hosts in the animal parasites, but the first
really great scientific demonstration of a widespread infection
through insects was by Theobald Smith, now of Harvard University,
in 1889, in a study of Texas fever of cattle.* I well remember the deep
impression made upon me by his original communication, which in
completeness, in accuracy of detail, in Harveian precision and in prac-
tical results remains one of the most brilliant pieces of experimental
work ever undertaken. It is difficult to draw comparisons in pathol-
ogy ; but I think, if a census were taken among the world's workers on
disease, the judgment to be based on the damage to health and direct
mortality, the votes would be given to malaria as the greatest single
destroyer of the human race. Cholera kills its thousands, plague, in
its bad years, its hundreds of thousands, yellow fever, hookworm
disease, pneumonia, tuberculosis, are all terribly destructive, some only
in the tropics, others in more temperate regions : but malaria is today,
as it ever was, a disease to which the word pandemic is specially ap-
plicable. In this country and in Europe, its ravages have lessened
enormously during the past century, but in the tropics it is everywhere
and always present, the greatest single foe of the white man, and at
times and places it assumes the proportions of a terrible epidemic. In
one district of India alone, during the last four months of 1908, one
quarter of the total population suffered from the disease and there
were 400,000 deaths — practically all from malaria. Today, the con-
trol of this terrible scourge is in our hands, and, as I shall tell you in a
few minutes, largely because of this control, the Panama Canal is
being built. No disease illustrates better the progressive evolution of
scientific medicine. It is one of the oldest of known diseases. The !
Greeks and Grseco-Romans knew it well. It seems highly probable,

3 Journal Linnaean Society, London, 1879, XIV, 304-311.

* Medical News, Philadelphia, 1889, LV, 689-693, and monograph with Kilborne, Washington,
1893.

f-

224 THE EVOLUTION OF MODERN MEDICINE

as brought out by the studies of W. H. S. Jones of Cambridge, that,
in part at least, the physical degeneration in Greece and Rome may
have been due to the great increase of this disease. Its clinical mani-
festations were well known and admirably described by the older
writers. In the seventeenth century, as I have already told you, the
remarkable discovery was made that the bark of the cinchona tree
was a specific. Between the date of the Countess's recovery in
Lima and the year 1880 a colossal literature on the disease had
accumulated. Literally thousands of workers had studied the various
aspects of its many problems; the literature of this country, particu-
larly of the Southern States, in the first half of the last century may
be said to be predominantly malarial. Ordinary observation carried
on for long centuries had done as much as was possible. In 1880,
a young French army surgeon, Laveran by name, working in Algiers,
found in the microscopic examination of the blood that there were
little bodies in the red blood corpuscles, amoeboid in character, which
he believed to be the germs of the disease. Very little attention at
first was paid to his work, and it is not surprising. It was the old
story of "Wolf, wolf"; there had been so many supposed "germs"
that the profession had become suspicious. Several years elapsed
before Surgeon-General Sternberg called the attention of the Eng-
lish-speaking world to Laveran's work: it was taken up actively in
Italy, and in America by Councilman, Abbott and by others among
us in Baltimore. The result of these widespread observations was
the confirmation in every respect of Laveran's discovery of the asso-
ciation with malaria of a protozoan parasite. This was step number
three. Clinical observation, empirical discovery of the cure, determi-
nation of the presence of a parasite. Two other steps followed
rapidly. Another army surgeon, Ronald Ross, working in India,
influenced hj the work of Manson, proved that the disease was trans-
mitted by certain varieties of mosquitoes. Experiments came in to
support the studies in etiology; two of those may be quoted. Mos-
quitoes which had bitten malarial patients in Italy were sent to
London and there allowed to bite Mr. Manson, son of Dr. Manson.
This gentleman had not lived out of England, where there is now no
acute; malaria. He had been a perfectly healthy, strong man. In a
few days following the bites of the infected mosquitoes, he had a
typical attack of malarial fever.

SANITATION 225

The other experiment, though of a different character, is quite as
convincing. In certain regions about Rome, in the Campania, malaria
is so prevalent that, in the autumn, almost everyone in the district
is attacked, particularly if he is a newcomer. Dr. Sambon and a
friend lived in this district from June 1 to September 1, 1900. The
test was whether they could live in this exceedingly dangerous climate
for the three months without catching malaria, if they used stringent
precautions against the bites of mosquitoes. For this purpose the hut
in which they lived was thoroughly wired, and they slept under
netting. Both of these gentlemen, at the end of the period, had
escaped the disease.

Then came the fifth and final triumph — the prevention of the dis-
ease. The anti-malarial crusade which has been preached by Sir
Ronald Ross and has been carried out successfully on a wholesale
scale in Italy and in parts of India and Africa, has reduced enor-
mously the incidence of the disease. Professor Celli of Rome, in his
lecture room, has an interesting chart which shows the reduction in
the mortality from malaria in Italy since the preventive measures
have been adopted — the deaths have fallen from above 28,000 in 1888
to below 2000 in 1910. There is needed a stirring campaign against
the disease throughout the Southern States of this country.

The story of yellow fever illustrates one of the greatest practical
triumphs of scientific medicine; indeed, in view of its far-reaching
commercial consequences, it may range as one of the first achievements
of the race. Ever since the discovery of America, the disease has been
one of its great scourges, permanently endemic in the Spanish Main,
often extending to the Southern States, occasionally into the North,
and not infrequently it has crossed the Atlantic. The records of the
British Army in the West Indies show an appalling death rate, chiefly
from this disease. At Jamaica, for the twenty years ending in 1836,
the average mortality was 101 per thousand, and in certain instances
as high as 178. One of the most dreaded of all infections, the periods
of epidemics in the Southern States have been the occasions of a wide-
spread panic with complete paralysis of commerce. How appalling
the mortality is may be judged from the outbreak in Philadelphia in
1793, when ten thousand people died in three months." The epi-
demics in Spain in the early part of the nineteenth century were of

5 Matthew Carey: A Short Account of the Malignant Fever, Philadelphia, 1T93.

226 THE EVOLUTION OF MODERN MEDICINE

great severity. A glance through La Roche's great book" on the
subject soon gives one an idea of the, enormous importance of the
disease in the history of the Southern States. Havana, ever since
its foundation, had been a hotbed of yellow fever. The best minds, of
the profession had been attracted to a solution of the problem, but all
iji vain. Commission after conlmission had been appointed, with
riegative results; various organisms had been described as the cause,
and there were sad illustrations of the tragedy associated with investi-
gations undertaken without proper training or proper technique. By
the year 1900, not only had the ground been cleared, but the work on
insect-borne disease by Manson and by Ross had given observers an
important clue. It had repeatedly been suggested that some relation
existed between the bites of mosquitoes and the tropical fevers, par-
ticularly by that remarkable student, Nott of Mobile, and the French
physician, Beauperthuy. But the first to announce clearly the mos-
quito theoi'y of the disease was Carlos Finlay of Havana. Early in
the spring of 1900, during the occupation of Cuba by the United
States, a commission appointed by Surgeon- General Sternberg (him-
self one of the most energetic students of the disease) undertook fresh
investigations. Dr. Walter Reed, Professor of Bacteriology in the
Army Medical School, was placed in charge: Dr. Carroll of the
United States Army, Dr. Agramonte of Havana and Dr. Jesse W.
Lazear were the other members. At the Johns Hopkins Hospital, we
were deeply interested in the work, as Dr. Walter Reed was a fa-
vorite pupil of Professor Welch, a warm friend of all of us, and a
frequent visitor to our laboratories. Dr. Jesse Lazear, who had been
my house physician, had worked with Dr. Thayer and myself at
malaria, and gave up the charge of my clinical laboratory to join the
commission.

Many scientific discoveries have afforded brilliant illustrations of
method in research, but in the work of these men one is at a loss to
know which to admire more — the remarkable accuracy and precision
of the experiments, or the heroism of the men — officers and rank and
file of the United States Army; they knew all the time that they were
playing with death, and some of them had to pay the penalty! The
demonstration was successful — -beyond peradventure — that yellow
fever could be transmitted by riiosquitoes, and equally the negative

6 R. La Roche: Yellow Fever, 3 vols., Philadelphia, 1855.

SANITATION 227

proposition — that it could not be transmitted by fomites. An interval
of twelve or more days was found to be necessary after the mosquito
has bitten a yellow fever patient before it is capable of transmitting
the infection. Lazear permitted himself to be bitten by a stray
mosquito while conducting his experiments in the yellow fever hospi-
tal. Bitten on the thirteenth, he sickened on the eighteenth and died
on the twenty-fifth of September, but not until he had succeeded in
showing in two instances that mosquitoes could convey the infection.
He added another to the long list of members of the profession who
have laid down their lives in search of the causes of disease. Of such
men as Lazear and of Mj^ers of the Liverpool Yellow-Fever Com-
mission, Dutton and young Manson, maj;' fitly be sung from the
noblest of American poems the tribute which Lowell paid to
Harvard's sons who fell in the War of Secession :

Many in sad faith sought for her,
Many with crossed hands sighed for her ;
But these, our brothers, fought for her.
At life's dear peril wrought for her.
So loved her that they died for her.

Fortunately, the commander-in-chief at the time in Cuba was
General Leonard Wood, who had been an army surgeon, and he was
the first to appreciate the importance of the discovery. The sanitation
of Havana was placed in the hands of Dr. Gorgas, and within nine
months the city was cleared of yellow fever, and, with the exception
of a slight outbreak after the withdrawal of the American troops, has
since remained free from a disease which had been its scourge for
centuries. As General Wood remarked, "Reed's discovery has
resulted in the saving of more lives annually than were lost in the
Cuban War, and saves the commercial interest of the world a greater
financial loss each year than the cost of the Cuban War. He came
to Cuba at a time when one third of the officers of my staff died of
yellow fever, and we were discouraged at the failure of our efforts to
control it." Following the example of Havana other centres were
attacked, at Vera Cruz and in Brazil, with the same success, and it is
safe to say that now, thanks to the researches of Reed and his col-
leagues, with proper measures, no country need fear a paralyzing
outbreak of this once dreaded disease.

228 THE EVOLUTION OF MODERN MEDICINE

The scientific researches in the last two decades of the nineteenth
century made possible the completion of the Panama Canal. The
narrow isthmus separating the two great oceans and joining the two
great continents, has borne for four centuries an evil repute as the
White Man's Grave. Silent upon a peak of Darien, stout Cortez with
eagle eye had gazed on the Pacific. As early as 1520, Saavedra pro-
posed to cut a canal through the Isthmus. There the first city was
founded by the conquerors of the new world, which still bears the
name of Panama. Spaniards, Enghsh and French fought along its
coasts; to it the founder of the Bank of England took his ill-fated
colony; Raleigh, Drake, Morgan the buccaneer, and scores of adven-
turers seeking gold, found in fever an enemy stronger than the
Spaniard. For years the plague-stricken Isthmus was abandoned to
the negroes and the half-breeds, until in 1849, stimulated by the gold
fever of California, a railway was begun by the American engineers,
Totten and Trautwine, and completed in 1855, a railway every tie of
which cost the life of a man. The dream of navigators and practical
engineers was taken in hand by Ferdinand de Lesseps in January,
1881. The story of the French Canal Company is a tragedy unparal-
leled in the history of finance, and, one may add, in the ravages of
tropical disease. Yellow fever, malaria, dysentery, typhus, carried off
in nine years nearly twenty thousand employees. The mortality fre-
quently rose above 100, sometimes to 130, 140 and in September, 1885,
it reached the appalling figure of 176.97 per thousand work people.
This was about the maximum death rate of the British Army in the
West Indies in the nineteenth century.

When, in 1904, the United States undertook to complete the Canal,
everyone felt that the success or failure was largely a matter of sani-
tary control. The necessary knowledge existed, but under the circum-
stances could it be made effective? Many were doubtful. Fortu-
nately, there was at the time in the United States Army a man who
had already served an apprenticeship in Cuba, and to whom more than
to anyone else was due the disappearance of yellow fever from that
island. To a man, the profession in the United States felt that could
Dr. Gorgas be given full control of the sanitary affairs of the Panama
Zone, the health problem, Avhich meant the Canal problem, could be
solved. There was at first a serious difficulty relating to the necessary
administrative control by a sanitary officer. In an interview which

SANITATION 229

Dr. Welch and I had with President Roosevelt, he keenly felt this
difficulty and promised to do his best to have it rectified. It is an open
secret that at first, as was perhaps only natural, matters did not go
very smoothly, and it took a year or more to get properly organized.
Yellow fever recurred on the Isthmus in 1904 and in the early part of
1905. It was really a colossal task in itself to undertake the cleaning
of the city of Panama, which had been for centuries a pest-house,
the mortality in which, even after the American occupation, reached
during one month the rate of 71 per thousand living. There have
been a great many brilliant illustrations of the practical application of
science in preserving the health of a community and in saving life, but
it is safe to say that, considering the circumstances, the past history,
and the extraordinary difficulties to be overcome, the work accom-
plished by the Isthmian Canal Commission is unique. The year 1905
was devoted to organization; yellow fever was got rid of, and at the
end of the year the total mortality among the whites had fallen to 8 per
thousand, but among the blacks it was still high, 44. For three
years, with a progressively increasing staff which had risen to above
40,000, of whom more than 12,000 were white, the death rate progres-
sively fell.

Of the six important tropical diseases, plague, which reached the
Isthmus one year, was quickly held in check. Yellow fever, the most
dreaded of them all, never recurred. Beri-beri, which in 1906 caused
sixty-eight deaths, has gradually disappeared. The hookworm dis-
ease, ankylostomiasis, has steadily decreased. From the very outset,
malaria has been taken as the measure of sanitary efficiency.
Throughout the French occupation it was the chief enemy to be con-
sidered, not only because of its fatalitj^ but on account of the pro-
longed incapacity following infection. In 1906, out of every 1000
employees there were admitted to the hospital from malaria 821 ; in
1907, 424; in 1908, 282; in 1912, 110; in 1915, 51; in 1917, 14. The
mortality from the disease has fallen from 233 in 1906 to 154 in 1907,
to 73 in 1908 and to 7 in 1914. The death rate for malarial fever
per 1000 population sank from 8.49 in 1906 to 0.11 in 1918. Dysen-
tery, next to malaria the most serious of the tropical diseases in the
Zone, caused 69 deaths in 1906; 48 in 1907; in 1908, with nearly
44,000, only 16 deaths, and in 1914, 4.* But it is when the general

*-Figures for recent years supplied by editors.

230 THE EVOLUTION OF MODERN MEDICINE

figures are taken that we see the extraordinary reduction that has
taken place. Out of every 1000 engaged in 1908 only a third of the
number died that died in 1906, and half the number that died in 1907.

In 1914, the death rate from disease among white males had fallen
to 3.13 per thousand. The rate among the 2674 American women
and children connected with the Commission was only 9.72 per thou-
sand. But by far the most gratifying reduction is among the blacks,
the rate from disease of which had fallen to the surprisingly low figure
in 1912 of 8.77 per thousand; in 1906 it was 47 per thousand. A re-
markable result is that in 1908 the combined tropical diseases^ma-
laria, dysentery and beri-beri — killed fewer than the two great killing
diseases of the temperate zone, pneumonia and tuberculosis — 127 in
one group and 137 in the other. The whole story is expressed in two
words, effective organization, and the special value of this experiment
in sanitation is that it has been made, and made successfully, in one
of the great plague spots of the world.

Month by month a little, grey-covered pamphlet was published by
Colonel Gorgas, a "Report of the Department of Sanitation of the
Isthmian Canal Commission." I have been one of the favored to
whom it has been sent year by year, and, keenly interested as I have
always been in infectious diseases, and particularly in malaria and
dysentery, I doubt if anyone has read it more faithfully. In evidence
of the extraordinary advance made in sanitation by Gorgas, I give a
random example from one of his monthly reports (1912) : In a popu-
lation of more than 52,000, the death rate from disease had fallen
to 7.31 per thousand; among the whites it was 2.80 and among the
colored people 8.77. Not only is the profession indebted to Colonel
Gorgas and his staff for this remarkable demonstration, but they have
offered an example of thoroughness and efficiency which has won the
admiration of the whole world. As J. B. Bishop, secretary of the
Isthmian Canal Commission, has recently said: "The Americans ar-
rived on the Isthmus in the full light of these two invaluable dis-
coveries [the insect transmission of yellow fever and malaria].
Scarcely had they begun active work when an outbreak of yellow
fever occurred which caused such a panic throughout their force that
nothing except the lack of steamship accommodation prevented the
flight of the entire body from the Isthmus. Prompt, intelligent and
vigorous application of the remedies shown to be effective by the

SANITATION 231

mosquito discoveries not only checked the progress of the pest, but
banished it forever from the Isthmus. In this way, and in this alone,
was the building of the canal made possible. The supreme credit for
its construction therefore belongs to the brave men, surgeons of the
United States Army, who by their high devotion to duty and to hu-
manity risked their lives in Havana in 1900-1901 to demonstrate the
truth of the mosquito theoj^ry."^

One disease has still a special claim upon the public in this country.
Some fourteen or fifteen years ago, in an address on the problem of
typhoid fever in the United States, I contended that the question was
no longer in the hands of the profession. In season and out of season
we had preached salvation from it in volumes which fill state reports,
public health journals and the medical periodicals. Though much has
been done, typhoid fever remains a question of grave national concern.
You lost in this state^" in 1911 from typhoid fever 154 lives, every one
sacrificed needlessly, every one a victim of neglect and incapacity.
Between 1200 and 1500 persons had a slow, lingering illness. A
nation of contradictions and paradoxes — a clean people, by whom
personal hygiene is carefully cultivated, but it has displayed in
matters of public sanitation a carelessness simply criminal : a sensible
people, among whom education is more widely diffused than in any
other country, supinely acquiesces in conditions often shameful
beyond expression. The solution of the problem is not very difficult.
What has been done elsewhere can be done here. It is not so much in
the cities, though here too the death rate is still high, but in the smaller
towns and rural districts, in many of which the sanitary conditions are
still those of the Middle Ages. How Galen would have turned up his
nose with contempt at the water supply of the capital of the Dominion
of Canada, scourged so disgracefully by typhoid fever of late ! There
is no question that the public is awakening, but many State Boards of
Health need more efficient organization, and larger appropriations.
Others are models, and it is not for lack of example that others lag
behind. The health officers should have special training in sanitary
science and special courses leading to diplomas in public health should
be given in the medical schools. Were the health of the people
made a question of public and not of party policj^ only a skilled expert

7 Bishop:. The French at Panama, Scribner's Magazine, January, 1913, p. 42.
'=• Connecticut.

232 THE EVOLUTION OF MODERN MEDICINE

could possibly be appointed as a public health officer, not, as is now so
often the case, the man with the political pull.

It is a long and tragic story in the annals of this country. That
distinguished man, the first professor of physic in this University in
the early years of last century, Dr. Nathan Smith, in that notable
monograph on "Typhus Fever" (1824), tells how the disease had
followed him in his various migrations, from 1787, when he began to
practise, all through his career; and could he return this year, in
some hundred and forty or one hundred and fifty families of the state
he would find the same miserable tragedy which he had witnessed so
often in the same heedless sacrifice of the young on the altar of
ignorance and incapacity.

TUBERCULOSIS

In a population of about one million, seventeen hundred persons died
of tuberculosis in this state in the year 1911 — a reduction in thirty
years of nearly 50 per cent. A generation has changed completely
our outlook on one of the most terrible scourges of the race. It is
simply appalling to think of the ravages of this disease in civilized
communities. Before the discovery by Robert Koch of the bacillus,
we were helpless and hopeless; in an Oriental fatalism we accepted
with folded hands a state of affairs which use and wont had made bear-
able. Today, look at the contrast ! We are both helpful and hopeful.
Knowing the cause of the disease, knowing how it is distributed, better
able to recognize the early symptoms, better able to cure a very con-
siderable portion of all early cases, we have gradually organized an
enthusiastic campaign which is certain to lead to victory. The figures
I have quoted indicate how progressively the mortality is falling.
Only, do not let us be disappointed if this comparatively rapid fall is
not steadily maintained in the country at large. It is a long fight
against a strong enemy, and at the lowest estimate it will take several
generations before tuberculosis is placed at last, with leprosy and
typhus, among the vanquished diseases. Education, organization, co-
operation — these are the weapons of our warfare. Into details I need
not enter. The work done by the National Association under the
strong guidance of its secretary, Mr. Farrand, the pioneer studies of

TUBERCULOSIS 233

Trudeau and the optimism which he has brought into the campaign,
the splendid demonstration by the New York Board of Health of
what organization can do, have helped immensely in this world-wide
conflict.

Some years ago, in an address at Edinburgh, I spoke of the triple
gospel which man has published — of his soul, of his goods, of his body.
This third gospel, the gospel of his body, which brings man into rela-
tion with nature, has been a true evangelion, the glad tidings of
the final conquest of nature by which man has redeemed thousands of
his fellow men from sickness and from death.

If, in the memorable phrase of the Greek philosopher, Prodicus,
"That which benefits human life is God," we may see in this new
gospel a link betwixt us and the crowning race of those who eye to eye
shall look on knowledge, and in whose hand nature shall be an open
book — an approach to the glorious day of which Shelley sings so
gloriously :

Happiness

And Science dawn though late upon the earth ;

Peace cheers the mind, health renovates the frame ;

Disease and pleasure cease to mingle here.

Reason and passion cease to combat there.

Whilst mind unfettered o'er the earth extends

Its all-subduing energies, and wields

The sceptre of a vast dominion there.

(Daemon of the World, Pt. II.)

INDEX OF PERSONAL NAMES

Abbott, Alexander C, 224.

Abelard, 27, 125.

Actuarius, Joannes, 91.

Adams, Francis, 60.

Addison, Thomas, 215.

Agramonte, Aristides, 226.

Agrippa, Henry Cornelius von Nette-

sheim, 119, 122.
Alaric, 84.
Albertini, Hippolito Francesco, 185,

188.
Albertus Magnus, 111, 113, 125.
Albucasis, 101.
Alcmaeon, 39-40, 43.
Alderotti, Taddeo, 105, 106.
Alexander the Great, 49.
AUbutt, Sir Thomas Clifford, 78, 110.
Amphiaraus, 67.
Anaximenes, 38.
Antiochus III, 79.
Antyllus, 185.
Apollo, 46, 49.
Apollonius of Tyana, 22, 78.
Aquinas, Thomas, 111, 113, 125.
Aretaeus, 200.
Aristarchus, 145.
Aristides, 57, 58.
Aristophanes, 52-63.
Aristotle, 43, 60, 69, 71, 72, 82, 110,

111, 113, 127.
Arnold, Matthew, 41.
Arnold of Villanova, 107, 110.
Asa, 3.

Asclepiades, 78.
Asklepios, 10, 43-58.
Atossa, 41, 42.

Auenbrugger, Leopold, 200, 203.
Averroes, 101, 104.
Avicenna, 97-101, 117, 127, 137.

Bacon, Francis, 125, 132, 134, 174.
Bacon, Roger, 113-115, 119, 124, 126,

126.
Baglivi, Giorgio, 193-194.
Baillie, Matthew, 198.
Ball, James Moores, 148.
Bayle, Antoine-Laurent- Jesse, 127.
Beauperthuy, Louis-Daniel, 226.
Beck, Theodor, 61.
Benivieni, Antonio, 184-185.
Bernard, Claude, 206, 214-215.
Bertalia, Michele, 116.
Berthelot, P.-E. Marcellin, 102.
Biagi, Guido, 60.
Bichat, M.-F.-X., 201, 203.
Boerhaave, Hermann, 185, 186, 190,

191, 193.
Bonetus, Theophilus, 186.
Boni, Giacono, 218.
Borelli, Giovanni Alfonso, 174, 176.
Boyle, Robert, 165, 179, 180.
Brassavola, Antonio Musa, 79.
Bright, Richard, 204.
Broca, Paul, 8.

Brown, John, 190, 191, 195-196.
Browne, Sir Thomas, 15, 122.
Browning, Robert, 35, 134, 137.

Caius, John, 128, 129, 131.

van Calcar, Jan Stephan, 151, 156.

Cardano, Girolamo, 121.

Carroll, James, 226.

Carter, Henry Vandyke, 163.

Cato the Censor, 27, 78.

Caton, Richard, 49, 62.

Cecco d'Ascoli, 119.

Celli, Angelo, 226.

Celsus, 7, 78, 127, 214.

Cesalpino, Andrea, 171, 172.

236

INDEX OF PERSONAL NAMES

Champier, Symphorien, 128.

Charcot, Jean-Martin, 206.

Charles V, 148, 159.

Charleton, Walter, 141.

Charras, Moses, 15.

Chaucer, Geoffrey, 125.

Chinchon, Countess, 183, 224.

Cholmeley, Henry Patrick, 95.

Cleanthes, 100.

Clement V, Pope, 107.

Clement VII, Pope, 145.

Cohn, Ferdinand, 209.

Cohnheim, Julius, 206.

Colombo, Matteo Eealdo, 170, 171.

Comrie, John D., 16.

Confucius, 31.

Constantinus Africanus, 88, 103.

Copernicus, Nicolaus, 144, 145, 182.

Corvisart, Jean-Nicolas, 200, 203.

Councilman, William T., 224.

Cowdry, Edmund V., 32.

Creighton, Charles, 195.

Croke, Sir Alexander, 89.

CuUen, William, 194-195.

Culpeper, Nicholas, 122, 123, 124.

Cumston, Charles G., 148.

Curtis, John G., 172.

Cusa, Cardinal, 145.

Cushing, Harvey, 155.

Dalton, John Call, 172.

Dannemann, Friedrich, 72, 85, 113,

146, 173.
Dante, 69, 125.

Daremberg, Charles- Victor, 90.
Darius, 41, 42.

Davy, Sir Humphry, 206, 220.
Democedes, 41-42.
Democritus, 220.
De Renzi, Salvatore, 87, 88.
Descartes, Rene, 174, 175.
Diels, Hermann, 60.
Digby, Sir Kenelm, 141-142, 143.
Diodes, 71.

Diogenes of Apollonia, 43.
Dioscorides, 90, 127.
Dryden, John, 142, 180.
Duclaux, fimile, 219.
Diirer, Albrecht, 162.

Dutton, Joseph Everett, 227.

Ebers, Georg, 12.
Ehrlich, Paul, 219.
Empedocles, 40-41, 67.
Epicurus, 220.
Erasistratus, 73-74, 76, 80.
Erasmus, 115.
Eryximachus, 64.
Eudoxus, 220.
Evans, Griffith, 214.

Fabricius ab Aquapendente, Hierony-

mus, 151, 163, 164, 166.
Fallopio, Gabriele, 160.
Farrand, Livingston, 232.
Ferguson, John, 113, 177.
Ferrari da Grado, Giammateo, 116, 117,

118.
Ferrari da Grado, Henri-Maxime, 116,

117.
Ficino, Marsilio, 184.
Finlay, Carlos, 226.
Flourens, Marie- J.-P., 172.
Fludd, Robert, 177.
Fracastorius, Hieronymus, 169, 208.
Frank, Joseph, 200.
Franklin, Alfred, 117.
Frederick II, 146.
Frederick of Urbino, Duke, 110.
Freind, John, 94.
Fuller, Thomas, 132.

Gaddesden, John of, 125.

Galen, 54, 74-83, 96, 102, 106, 115,
117, 126, 127, 131, 132, 152, 164,
167, 158, 159, 160, 170, 171, 172,
173, 231.

Galileo, 173, 174.

Garrod, H. W., 26, 27.

Ga-th, Samuel, 123.

Geber, 102.

Gerard of Cremona, 103.

Gerbert, 103.

Gerhard, William W., 204.

Gesner, Conrad, 127, 130, 131.

Gibbon, Edward, 84.

Gilbert, William, 180-182.

INDEX OF PERSONAL NAMES

237

Gildersleeve, Basil L., 64.

Giliani, Alessandra^ 106.

Gomperz, Theodor, 36-37, 38, 63, 66,

70, 71.
Gorgas, William Crawford, 227, 228-

230.
de Gorter, Johan, 33.
Graves, Robert, 204.
Gray, Henry, 163.
Greenhill, William Alexander, 96.
de Groot, J. J. M., 31.
Grosseteste, Robert, 124.
Gjiinterius, Joannes, 148.
Guy de Chauliac, 107, 109.

de Haen, Anton, 193.

Hales, Stephen, 174.

Hall, Marshall, 204.

von Haller, Albrecht, 193.

Hamilton, Mary, 58.

Han Yii, 31.

Harrison, Jane, 3.

Hartmann, Julius, 134.

Harvey, William, 163-174, 182, 220.

Hegel, G. W. F., 219.

Heraclitus, 39.

Herodotus, 38, 41.

Herophilus, 73.

Hertzog, Rudolf, 53.

Hippocrates, 58-69, 79, 83, 115, 117,

125, 127, 131, 132, 190, 191, 200,

218.
Honein, 95.

Honorius IV, Pope, 105.
Hooke, Richard, 174.
Howell, James, 142.
Hunter, John, 196-198, 199, 206.
Hygieia, 46, 47.

Ibn Sina. See Avicenna.
Imhotep, 10.
Imouthes, 10.
Isaac, Judffius, 11'5.
Isaiah, 69.

Jackson, A. V. W., 100.

Jackson, Thomas J. ("Stonewall"),

124.
Jastrow, Morris, 18-22, 23, 24, 27, 48.

Jenner, Edward, 198-200, 212, 220.

Jeremiah, 16.

Joannitius, 95.

John XXI, Pope, 111, 112.

Jones, W. H. S., 224.

Kingsley, Charles, 94.

Kipling, Rudyard, 124.

Kircher, Athanasius, 208.

Koch, Robert, 209-212, 214, 220, 232.

Kuhn, Carl Gottlob, 79.

Kulmus, Joannes Adamus, 33.

Laennec, Rene-Theophile, 203-204, 205.

Lancisi, Giovanni Maria, 192, 193.

Lankester, Sir Edwin Ray, 5.

La Roche, R., 226.

Laveran, Alphonse, 214, 224.

Lazear, Jesse W., 226, 227.

Leclerc, Lucien, 94, 95, 96, 100, 103.

Lee, Frederick S., 217.

van Leeuwenhoek, Antonj, 208.

Leonardo da Vinci, 155, 157, 161, 162,

163.
de Lesseps, Ferdinand, 228.
von Liebig, Justus, 216.
Linacre, Thomas, 127-128.
Linnaeus, 184.

Lister, Joseph, Lord, 212-214, 219.
Littre, Emile, 61, 66, 67, 70.
Livingstone, R. W., 36, 37.
Livy, 49.

Locke, John, 183.
Long, Crawford W., 206.
Longfellow, Henry W., 88.
Louis XI, 117.
Louis, P.-C.-A., 204.
Lowell, James Russell, 227.
Lower, Richard, 174.
Loyola, Ignatius, 150.
Lucas-Championniere, J.-N., 8.
Lucian, 49.
Lucretius, 5, 7, 35.
Luther, Martin, 135, 145.

Maean, R. W., 42.
Machaon, 43.
Magendie, Fran9ois, 206.
Makrizi, 102.

238

INDEX OF PERSONAL NAMES

Manilius, 25.

Manson, Sir Patrick, 224, 226.

al-Mansur Gilafun, 102.

MarcAntonio della Torre, 162.

Marcus Aurelius, 77.

Maspero, G., 11, 12.

Mayeno, 33.

Mead, Richard, 157.

Mehren, M. A. F., 101.

Melanchthon, Philipp, 145.

Mesues, the, 96.

Meyer-Steineg, Theodor, 78.

Michael Xngelo, 162.

Mitchell, S. Weir, 173-174.

de Mondeville, Henri, 107-108, 146.

Mondino dei Luzzi. See Mundinus.

Montagu, Lady Mary Wortley, 180.

Montanus, Joannes Baptista, 152.

Moore, Norman, 89.

Morgagni, Giovanni Battista, 185-189,

204.
Morton, William T. G., 206.
Moses, 28.

Mundinus, 106, 107, 116, 125, 148.
Murray, Gilbert, 3, 24-25, 62.

Naude, Gabriel, 113.

Neligan, Anthony Richard, 101.

Nelmes, Sarah, 199.

Nestor, 43.

von Nettesheim. See Agrippa.

Neuburger, Max, 28, 52, 98, 102, 146.

Nicaise, Edouard, 108, 109.

Nicolaus Salernitanus, 88, 115.

Nikander, 49.

Nikon, 74.

Nott, Josiah Clarke, 226.

Numa, 4.

Oehler, Johann, 43.

Omar Khayyam, 100.

Oporinus (Herbster), Johannes, 154.

Oribasius, 90.

Osiander, 145.

Pagel, Julius, 108.

Panaetius, 27.

Paracelsus, 132-140, 176, 178.

Pasteur, Louis, 206-209, 212, 214, 220.

Pater, Walter, 4, 54.

Paul of ^gina, 94.

Payne, Joseph Frank, 7.

Perkin, Sir William, 220.

Peter of Abano, 110.

Petrus Hispanus, 111.

Phaer, Thomas, 67.

Philostratus, 22, 57, 78.

Phipps, James, 199.

Pitcairne, Archibald, 176.

Plater, Felix, 148, 155.

Plato, 42, 58, 60, 62, 64, 69, 100, 101.

Pliny, the Elder, 3, 7, 13, 14, 15, 16,

25, 66, 71, 73, 78, 79, 127.
Podalirius, 43.
Pohl, Rudolf, 43.
Poliziano, Angelo, 184.
Poly crates, 41.
Polydamna, 16.
Porphyry, 71.
Pottier, E., 43.
Praxagoras, 71-72, 73, 80.
Prodicus, 62, 233.
Protagoras, 58, 220.
Ptolemy, 10, 72, 87, 103.
Pylades, 76.
Pythagoras, 39, 145.

Rabelais, Frangois, 120-121, 122.

Raphaels, 162.

Rashdall, Hastings, 104, 118, 119.

Rattray, Sylvester, 141.

Redi, Francesco, 208.

Reed, Walter, 226, 227.

Regiomontanus [Miiller], Joannes, 145.

Revere, J. W., 124.

Rhazes, 96, 98, 117, 137, 150.

Richet, Charles, 81, 172.

Robert of Normandy, 89.

Roosevelt, Theodore, 229.

Ross, Sir Ronald, 224, 225, 226.

Roth, Moritz, 148, 154.

Rouxeau, 203.

Ruffer, Sir Marc Armand, 17.

Rush, Benjamin, 195.

Rutherford, John, 194.

Saavedra, 228.

INDEX OF PERSONAL NAMES

239

Sambon, Louis, 225.

Saint Gregory, 86.

Saint James, 29.

Saint Jerome, 85.

Saint Luke, 30.

Saint Paul, 62, 85.

Sanctorius, Sanctorius, 173, 174.

Saunders, William, 194.

Schaudinn, Fritz, 214.

Schonlein, Johann Lucas, 204.

Scott, Sir Walter, 142.

Sennert, Daniel, 178.

Servetus, Michael, 121, 157, 171.

Sethe, Kurt, 10.

Shelley, Percy Bysshe, 1, 37, 233.

Skoda, Josef, 204.

Slater, D. A., 35.

Smith, Grafton Elliot, 10, 16, 102.

Smith, Nathan, 232.

Smith, Theobald, 223.

Socrates, 42, 65, 69, 220.

Soddy, Frederick, 2.

Soranus of Ephesus, 60.

Spallanzani, Lazaro, 208.

Sprengel, Kurt, 189.

Stahl, Georg Ernst, 179, 189.

Sternberg, George Miller, 224, 226.

Stirling-Maxwell, Sir John, 151.

Stoddart, Anna M., 134, 136, 140.

Stokes, William, 204.

Strunz, Franz, 134.

Strunz, Karl, 134,

Sudhoif, Karl, 134, 138.

van Swieten, Gerhard, 193.

Swift, Jonathan, 115, 122.

Swinburne, Algernon Charles, 5.

Sydenham, Thomas, 189, 190.

Sylvester II, Pope, 103.

Sylvius, Franciscus, 178-179, 190.

Sylvius, Jacobus, 148, 159.

Tacitus, 25.

Tagliacozzi, Gasparo, 142.

Talbor, Robert, 183-184.

Taylor, Henry Osborn; 85, 103.

TertuUian, 85.

Thayer, William Sydney, 222, 226.

Theophrastus, 71'.

Thompson, Silvanus, 182.

Thorndike, Lynn, 13.

Traube, Ludwig, 206.

Trithemius, Johannes, 135.

Trudeau, Edward Livingston, 233.

Tylor, Sir Edward B., 5.

Valentine, Basil, 176.

Valsalva, Antonio Maria, 185, 186.

Van Helmont, Joannes Baptista, 139,

140, 141, 142, 178.
Vesalius, Andreas, 121, 146-163, 166,

184.
Virchow, Eudolph, 205, 219.

Waite, A. E., 134, 138.

Walsh, James J., 29, 124.

Welch, William Henry, 226, 229.

Wells, William Charles, 204.

Wharton, Edith, 160.

Whytt, Robert, 194.

Williams, C. J. B., 204.

Withington, Edward T., 4, 67, 98, 176,

179.
Wood, Leonard, 227.
Wreszinski, Walter, 12.

Xenophanes, 4.

Yonge, James, 119.

Zoser, 10.

INDEX OF SUBJECTS

Acoustics, 39.

Acupuncture, 31, 32, 33.

Adrenalin, 216.

Alchemy, 135, 137, 176.

Almanacs, 122, 123-124.

Anaesthesia, Surgical, 206.

Anatomy, 33, 80, 104, 106, 201; Alex-
andrian, 73-74; Renaissance, 146-
163.

Aneurysm, 184.

Angina pectoris, 188.

Anicia Juliana MS., 90, 91.

Anthrax, 209, 211, 212.

Aqueducts, Roman, 83.

Arabians, 91-95.

Archaeus, 137, 139, 140, 178.

Arteria tracheia, 72.

Arteries, 72.

Asclepieia, 49-58.

Astrology, 22-27, 29, 31, 110, 119-125,
138-139.

Astronomy, 145.

Auscultation, 203-204.

Bacteriology, 204-206.

Barber surgeons, 106, 118.

Beer, Diseases of, 209.

Blood, Circulation of, 80-82, 157-159,

163-173.
Bloodletting, 118, 138, 178, 200.
Blood vessels, 70, 72.
Body-snatching, 106, 148.
Bologna, University of, 104-106, 117.
Botany, 71, 111.
Brain, 39.

Chemistry, 15, 102, 136, 176-179.
Christianity, 84-86.
Cinchona, 183-184, 224.

Civilization, 2.
Consultations, 117.
Contagium mvum, 208.
Contraries, Doctrine of, 140.
Copper, 102.
Cos, 53, 55.

Demons, 17.

Diagnosis, 200, 203, 205.

Dissection, 33, 69, 106, 109, 146, 148,

151, 155.
Divination, 18-22, 29, 119-125.
Drainage, 83.
Drawings, Anatomical, 149, 151-155,

157-158, 161-163.
Ductless glands, 215-216.
Dysentery, Amoebic, 214.

Edessa, 91.

Education, Medical, 73, 104-118, 178.

Egypt, 2, 72.

Elements, Doctrine of, 67.

Epidaurus, 49-53.

Ether, 206.

Eustachian tubes, 39.

Evil Eye, 22.

Experiment, 113.

Fees, Medical, 77, 105.
Fermentation, 206, 209.

Galenicals, 118, 137.

Generation, Spontaneous, 208-209.

Glycogenic function, 215.

Gods, Medical, 4-5.

Goitre, 215.

Gout, 138.

Greece, 35-38.

Guilds, 104.

242

INDEX OF SUBJECTS

Hammurabi Code^ 26-28.
Heart, 73-74, 81-82.
Heart disease, 193, 206.
Heat, Innate, 73.
Hepatoscopy, 18-22.
Heterogenesis, 208.
Histology, 201.
Horoscopes, 121.
Hospitals, Arabian, 102.
Hudibras, 142.

Humors, Hippocratic, 108, 118.
Hygiene, 222-232.

latromechanical school, 174, 176.
Illustration, Anatomical, 149, 151, 152,

153, 154, 155, 157, 158, 161, 162,

163.
Immunity, 14.
Incantations, 17-18.
Incubation, 57-58.
Infection, Science of, 208-214.
Inoculation, Preventive, 33, 212.
Insects, 222.

Instruments, Scientific, 173.
Isonomy, 39.
Incunabula, Medical, 89, 96, 105, 112,

126-127.

Jesuits' bark, 183-184.
Joseph's cup, 21, 28.

Laudanum, 137.
Lemuralia, 22.
Libraries, Medical, 117.
Liver, Inspection of, 18-22.
Lourdes, 29, 54.

Macrocosm, 144-145.

Magic, 3, 110.

Magnetism, 141.

Malarial fever, 183-184, 214, 222.

Manuscripts, Medical, 12, 60, 61, 90,

91, 98, 99, 100, 117-118, 149, 167.
Materia medica, 71, 90, 118, 127.
Mathematics, 103.
Measles, 96.
Medicine, Alexandrian, 71-74; Arabian,

91-104; Assyro-Babylonian, 17-28;

Byzantine, 90; Chinese, 30-33; clini-
cal, 178-179, 189-196, 200; Egyp-
tian, 9-17; Greek, 35-83; Japanese,
33-34; Jewish, 28-30; mediaeval, 84-
125; modern, 183-233; practice of,
118; preventive, 218-233; primitive,
3-9; Renaissance, 126-163; Roman,
74-83; seventeenth century, 163-182.

Metabolism, 216, 217.

Microcosm, 144-145.

Microscope, 173, 205, 208.

Miracles, 29.

Montpellier, University of, 107-110,
117.

Mosquitoes, 223-227.

Mutnia, 140, 141.

Museums, 197-198.

Myxcedema, 216.

Natural history. 111.
Nature philosophy, 38-40.
Nephritis, 204.
Neurology, 206.
Nestorians, 91, 95.
Nitrous oxide, 206.
Non-naturals, 118.
Numbers, Doctrine of, 39.

Oath, Hippocratic, 63-64.
Optic nerves, 39.
Organotherapy, 33, 140.
Osteology, 80.

Padua, University of, 110, 117, 146,
151-152, 163-165.

Panama Canal, 228-231.

Panta rei, 39.

Papyri, Medical, 12-13.

Paris, University of, 117.

Pathology, 184-189, 198; cellular, 205,
219; experimental, 206.

Pavia, University of, 115-117.

Percussion, 200.

Pergamos, 74, 75, 76, 77.

Pharmacy, 137.

Philosophy, Ionian, 38-39; South Ital-
ian, 39-41.

Physiology, 73-74, 80-82, 157-159, 163-
176.

INDEX OF SUBJECTS

243

Plague, Bubonic, 86.

Pneuma, 72.

Post-mortem examinations, 184-185.

Printing, Early, 126-127.

Protozoa, Pathogenic, 214.

Pulse, 73, 76, 174.

Pulse-Counting, 73.

Pulse-lore, Chinese, 32-33.

Pulsilogue, 174.

Pulr' Comitissw, 183.

Quadrivium, 119.

Radium, 2.

Regimen sanitatis, 89, 107.
Relapsing fever, 214.
Religion, 5.
Rosicrucians, 140, 177.

Salaries, Professors', 116.

Salernum, School of, 87-89, 106, 127.

San Vitale, 106, 107, 116.

Sanitation, 222-232.

Secretions, Internal, 215-216.

Semen, 39.

Serotherapy, 14.

Signatures, Doctrine of, 7, 140-141.

Silkworm, Diseases of, 209.

Smallpox, 96, 198-200, 202.

Spine, Delineation of, 153, 161.

Spirits, Animal, 73.

Spirits, Vital, 73.

State physicians, 41, 42.

Stercorife, 86.

Stethoscope, 203.

Suprarenal glands. Disease of, 215.

Surgery, 8-9, 101, 185, 196-198; anti-
septic, 212-214; aseptic, 219; me-
diaeval, 107-110, 118; plastic, 142-
144.

Sympathy, Doctrine of, 140.

Syphilis, 185, 193, 214.

Taoism, 30, 31.

Telescope, 173.

Temple sleep, 57-58.

Texas fever, 223.

Theodosian code, 27.

Therapeutics, Origin of, 7.

Theriaca, 79.

Thyroid gland. Diseases of, 215.

Title-pages, Medical, 89, 96, 105, 123,

136, 143,^156, 168, 179, 181, 184,

187, 200, 204, 211.
Tracheotomy, 185.
Translations, Mediaeval, 103, 104.
Trephining, Prehistoric, 8.
Tropical diseases, 214, 229-231.
Trypanosoma, 214. "^ _

Tubercle bacillus, 214.
Tuberculosis, 203, 232-233.
Typhoid fever, 231-232.
Typhus fever, 222.

Universities, Mediaeval, 104-118, 119.
Uroscopy, 91.

Vaccination, 198-200, 202, 212.
Veins, Valves in, 163, 164, 165.
Vis medicatrix naturce, 66, 68, 140.
Vision, 39.
Votive tablets, 54, 56, 57.

Water-casting, 91.
Water supply, 83.
Weapon salve, 141.
Wines, Diseases of, 209.
Wounds, 141; infection of, 211; mag-
netic cure of, 178.
Wu-ism, 30-31.

Yang, 30.

Yellow fever, 225-232.

Yin, 30.

Zodiac, 231.

PMNTED IN THE UNITED STATES OF AMERICA